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DUKE HOSPITAL LIBRARY
DURHAM, N. C.

Rec'd

THE

NEW-ORLEANS

MEDICAL AND SURGICAL

JOURNAL.

VOLUME IX.

A. HESTER, IH. D.,

EDITOR AND PROPRIETOR.

summtjm EomjM medicinje, s anitas. — Galen,

W. O. Charity Hosphil.

NEW-ORLEANS :

PRINTED BY JOSEPH COHN, 81 POYDRAS STREET.

1853.

Digitized by the Internet Archive
in 2015

https://archive.org/details/neworleansmedicaOOhist

INDEX

To Vol. IX. of the New Orleans Medical and Surgical Journal, from
July, 1852, to May, 1853.

Bftckell, D. W., on probing the

Abdomen, wound of;by J A Coons 115
" « by A. Ewing 764

Abortion, are physicians authorized
to resort to, to save the mo-
ther, - - ^ 268
" on the induction of, in vom-
iting of pregnant women,by
MM. Dubois and Stoltz, 520
Abstinence, remarkable case of, 112
Aconite, a remedy for rheumatism, 689
Albuminuria, temporary,by Begbie, 784
Anatomy, pathological, by T. J.

Holland, 246
Anaesthesia in midwifery ,report on,

by H. Miller, - - 801

Anthrax, by Dr. Wharton, 598
Artery, vertebral ligature of the, 375
Artificial respiration, by Dr. Ely, 209
Asphyxia,deathfrom,by Dr.Meux, 556
Bernard, M. physiological research-
es of, - - - - 370
Billiary calculus in hepatic duct,

death from, by Dr. Waller 648
Blood, motive power of the, by A,

W. Ely, - - 41,348
" abortion and transfusion of,

by Dr. Rouanet, - 111
" on separation of an excess of

water from the, - 23 1
" corpuscles, suggestions on,

by J. C. Cumffiinas, 422
" letting.essay on, by lvr.Clow,438
" iron and manganese in dis-
eases of the, - - 786
Blake, Dr. on the climate and dis-
eases of California, 504
Bodily temperature and pulse, by

Lichenfels and Frolich, 78 1

Boils, yeast in treatment of the,

by Dr. Moss , - 513

Boling, W. M. on the use of qui-
nine in continued fever, 1
" on the effects of quinine on

the pulse, - - 746
" on opium taking, - 750
Botanical contributions, by J. L.

Riddell, ---- 609
Brain, specific gravity of the, 692

fallopian tubes, - - 263
Bronchitis, ligature of inferior and

superior arteries a cure for, 787
Browning, G. T., on strangulated

femoral hernia, - . 618
Births, marriages and deaths in

Boston, report of, - - 801
Buboes, collodion in treatment of, 835
Cahawba, diseases of, by Dr.Eng-

lish, 340
California, climate and diseases of,

by Dr. Blake, - 504
" present hygienic condition
' of, by Thomas M. Logan, 8
Camphor, an antidote for poison

of strychnine, - - 572

Cancer, statistics of, by J. Paget, 626
" lactate of iron in treatment

of, by Dr. Brainard, 90
" of stomach, by Dr. Wilson, 239
Cartwright, S. A., on probing the

fallopian tubes, 75
" on the negro constitution, 195
" haematokinety, - 214
Cell development, pathology of, 359
Cells, organic,on the chemistry and

vitality of, by J. L. Riddell, 458
Cerebro-spinal meningitis, obser-
vations on, by R. F. Taylor, 184
Caesarian operation in a well form-
ed pelvis, case of, by B. Harvey, 772
Charity Hospital, reports of,

141, 286,566, 703, 851
" report of administrators, 677
Chemistry, elements of, by Thos.

Graham, - - 107
" a letter on, by Dr. Kennedy, 402
Chavanne, M., on vulvitis, 522
Children,diseases of,by Dr. Shew, 650
Chloroform, resuscitation from, 403
" prevention of death from, 87
" in dislocations, by Dr.

Hurlbut, 113
" in obstruction of the bow-
els from spasms,byDr.
Cain, - - 635
" in tetanus, efficacy of, 87

DEX.

Cholera in Ca)ifornia,by W.Taylor, 53
" in Sacramento,by Dr.Logan,488

" mineral acids in, - 137

" in Columbus, Ohio, - 367

" Dr. Hester on, - - 707

Chorea, strychnine a cure for, 396

" colchicum in, - 267

Clinical notes, by R. L. Scruggs, 26
Clow, John J. on blood-letting, 438
Cod liver oil in tubercular affec-
tions.by R. L Scruggs, 583
" new mode administering, 269
Consumption, treatment of, 640
Consumption in the South, 848
Contributions, original, 133
Copaiba, mode of administration,

by M. Chervet, - - 94

Coopers Well Water, medical

virtues of, by J, F. Kennon, 724
Coroner's Inquest, - - 127

Coup de soleil, case of, 279
Croup, chlorate of potash in, 785

" cauterization in, 838
Crystalline deposits, detection of,

by H. Hassall, - ) - 228
Cutaneous diseases, starch in, 401
Cummings, J. C, on blood cor-
puscles in living animal system, 422
Cystitis, acetate lead injections in, 399
Damages forwantof skill,suit for, 5l4
Deaths in the city of Philadelphia, 688

« " Baltimore, 688

« " New Orleans, 126

Dental medicine, treatise on, by

T. E. Bond, - * 679

" surgery, college of, - 284
Diabetes, treatment of, by Bou-

chardet, 692
Dickson, prof., life, sleep, pain,

esays on, - - - 106
Disease, God in, by J. F Duncan, 386
Douch in fever, efficacy of, 560
Double uterus, by Dr. Macgibbon. 129
Douglas, J. H. on inflammation

of the Nostrils, - - 604
Dowler, Bennet, on experimental

physiology, 58

14 honors to, - 851

" contributions to physiology, 121
Drake, Daniel, - - 563

" life, character and services

of, by Dr. Gross, 801
Dream, the chemist's, - 794

Dropsy, effects of colchicum in, by

Dr. McLean, - - 356

Dmggist, receipt book of, by H.

Beaeley, - - - 668

Dysentery, large doses of opium in,

by Dr. Stuart, 549
" salines in, by Dr Gordon, 188
" iodine clysters in treatment

of. by Dr. Eimer, 361
11 and cholera, - - 367

Eau Pagliari, haemostatic effects

of, by prof. Sedillot, - 780
Editorial notices,

126, 276, 415, 560, 697, 843
Ely, A. W., on the motive power of

the blood, 41, 384

" on artificial respiration, 200
" on the order of Hippoerates.709
Epileptics, hospitals for,by Dr.Hall,5l5
Epilepsy, cauterization larynx in, 700
EnglishJ. A. on health of Cahawba.384
Essay, prize for the best, 841
Eve, P. F. - 840

" on dislocation of os humeri, 580
" on urinary calculus, 124
Ewing, A., on wound of abdomen, 764
Eye, hydrocy. acid in affections of, 273
" dislocation of, by Dr. Jameson, 689
Fallopian tubes, practicability of

probing,by S.A.Cartwright, 73
" probing of, by Dr. Brickell, 263
Farrell, Dr., - - - 850
Fenner, E. D.. on abortive treat-
ment of fevers by sulph. quinine, 318
Fever, continued, reports on, by A.

Flint, 380
" " quinine in,by Dr. Fen-
ner, - - 318
" " quinine in, by Dr. Bo-
ling, - - 1
£; " quinine in, by J. C.H. 255
" typhoid, discussion on, 557
" " morphine in treatment, 95
" " in the country, by H.

C. Hillhouse, 120
" " South, treatment of, 400
" " modified treatment of, 404
" " treatment,by Dr.Todd, 273
" " in the negro, by H. A.

Ramsay, 819
" typhus, sulph. quine in the

treatment of,Dr. McEvers, 636
" yellow, by J. C. Massie. 35
" - - - 418

" " causes of, 691
" byThos. D.Mitchell, 717
" scarlet, kreosote in, 271

" intermittent, chlor.sodium in, 399
" paroxysmal,quinine and opium
in cold stages of,by A.He&t<3r,555

INDEX.

Fever, congestive, cold douche in,

by A. Patton, 560
" bilious, use of purgatives in,

by S. G. Armor, 622
" periodic, is typhoid or pneu-
monia identical with, by S.
L. Grier, - - 427

Fork from thigh, extraction of, 836
Fractures, chloroform in, 113
" bv acupuncture, treatment

of, by M. Lenoir, 234
Frydinger, Dr. on tape worm, 135
Fugate, V. H., on tetanus, 193
Galvanism, in poisoning by laud-
anum, - - 785
Gastric juice, by Bence Jones, 232
Giddings', prof, address, 98
Gordon, F. E., on salines and opi-
ates in dysentery, - 188
Gorup-Besanes,on detection of mer-
cury in post mortem, 519
Gum resins, suspension of, by M.

Poulenc, - - - 94

Gun-shot wound, case of, 21
" " of neck, 375

Gutta percha catheters, danger of,

by VV. W. Morgan, - 839

Grier, S. L., on periodic fevers, 427
" on negroes' diseases, 752
Haematology, researches on. 799
Hajmatokinety, remarks on, by

S. A. Cartwright, 214
Hale, Josiah, on the medical botany

of Louisiana, .- 152,285

Hall,M. on hospitals for epileptics, 715
Hand,wound of, by J.C. Hamilton, 395
Harvey, B. on caesarian operation, 772
Health,mortality,etc. of N. Orleans,

126, 276, 415, 553, 697, 843
" of country, by Dr. Patten, 560
Heart affections, ferruginous pre-
parations in, - - 360
Hemorrhage, arterial, arrested by

flexion of the limbs, 86
" secondary,by Dr.Macgibbon,702
" uterine,success of pressure in,l 14
" a new styptic for, 786
Hernia, by T. G. Browning, 618
Hester, A., on rupture of spleen, 278
" on quinine and opium in
cold stages of paroxys-
mal fevers, - 555
" on mortality in U.S. Navy, 705
Hiccough, obstinate nervous, 267
Hip joint, dislocations of, 413
Hippocrates, order of. by A. W.
Ely, .... 709

Homoeopathy, claims of, - 357
Homoeopathic revelry, - 635

Hooping cough, arsenic in treat-
ment of, by Dr. Nye, 282
" and asthma, nitric

acid in, 401
" cured by cauterization

of the glottis, 403
Hort, W. P. on midwifery and dis-
eases of women and children,

472, 567
Hospital, marine, (U.S.) analytical
report of, by P. B. McKelvey,

285, 425, 694
" Pennsylvania,address on foun-
ding of, by G. B.Wood, 104
" " (insane) report of, by T.

Kirkbridge, 801
" Mississippi State, analytical

report of,by C.S.Magoun,l24
« " history of, by C. S. Ma-

goun, - - 342
Human physiology, principles of,

by W. B. Carpenter, 669
Hydropathic encyclopedia, by Dr.

Trail, - - - - 540

Hydrocianic acid, topical applica-
tion of to the eye, - - 273
Hypertrophy, under what circum-
stances does it occur, - 632
Hippocrates,character and writings

of, by Elisha Bartlet, - 674
Hysteria, colchicum in, - 267
Indigestion, a remedy for, 786
Infants, catarrh and pneumonia in,

by Treausseau, - - 365
Infanticide, by immersion in pulve-
rulent substances, - - 79
Insanity, by P. B. Castelneau, 241
Intestinal obstruction, a case of, 698
Iodide of potassium, a remedy for

lead and mercury, - - 693
Jackson county springs, analysis

of, by Dr. Smith, - - 269
Jackson, Dr. address before Med.

Society Phil. Co. - - 98
Jaw, (lower) on claims of priority

in exsection and disarticulation of,98
Joints, iodine injections of, by M.

Velpeau, - - 690

Kennon, J. T. on Cooper's Well, 724
Kreosote in scarlet fever, - 271
Laryngisimus, etc., by Dr. Hall, 788
Larynx, new mode of cauterizing, 788
" cauterization of, - 845
Laudanum, poisoning by an over-
dose of, - 785

18714

INDEX.

Lead, iodide of potassium a remedy
for affections caused by, 693
" colic, chloroform in, 528
Lee, R. on rupture of the uterus, 526
Life, sleep, pain, by Dr. Dickson, 106
Life insurance, by Dr. Knapp, 8 1 9
Lillie, D T. meteorological journal,

141, 286, 426,556, 703,851
Lithotomy, by Charles Delery, 5H5
Limbs, flexion of, in hemorrhage, 86
Liver, hydatids of the,by E. Weber, 819
" wound of, by J. C. Massie, 146
Logan, T. M. on cholera in Sa-
cramento, - - 488
" on the hygienic condition of
California, 8
Lunatic asylum, (Ohio.) 13th an-
nual report, - 98
Lung, traumatic lesion of - 94
Lungs,how tubercles are formed in,£67
Macgibbon, D. complimentary to, 559
" on double uterus, 129
" on secondary hemorhage,702
Macrocosm and Microcosm, by

W. Fishbough, - -. 813
Madness, vinegar a remedy for, 649
Magoun, C. S.^ on life Dr.Metcalf, 484
" on Natchez as a residence

for consumptive invalids, 2]
" on Mississippi State hospital, 342
Malgaigne, M. on aneurism, 522
Mammary region, anatomy of, by

M. Geraldes, - 337
Massie's (J.C ) Southern Practice,706
" on gun shot wound, 2l
" on yellow fever, - 35

" on wound of the liver, 146
Materia Medica. by W. Tully, 671
" outlines of, by W. Frost. 246
Medical Association, - a 08

" " Alabama, 246.840

" " Missouri, 386

" " National Eclectic, 529

" Society, Boston, - 642

" " Kentucky, - 817
" Virginia, - 386

" " Georgia, - 386

" " (Med. Ph.) N.Orleans, 563
" . Louisiana State,

564, 705, 848
" profession, South and West, 275
" " Alabama, to the, 842

" botanv of Louisiana, by Jo-

siah'Hale, 152, 287

" Journal of Virginia, 666
" department Univ. Louisville,667
Nashville, 801

f Medical life in London, - 686
" schools, on, - - 281
" men, relief of widows of, 627
" convention, Texas, - 816
Medicale de la Louisiana, 1'Union, 564
Medio-carpan, by M. Maisoneuve, 338
Memphis, mortuary statistics of, 12
" medical college, - 128
Men and animals, geographical dis-
tribution of, by J. C. Nott, 727
Mental alienation, treatment of, 696
Mercury, detection of, - 519

" iod. potassium a remedy for, 693
Merrill, prof, on sore throat, 148
Metcalf, V. E., sketch of, by C.

S. Magoun, - - - 484
Meteorological Journal,

141, 286, 426, 566, 703, 851
Meux, T. O. on asphyxia, 556
Microscope, binocular, - 407
Microscopic observations, by J.

L. Riddell, 116, 173

Midwifery, by M. Velpeau, 104
" by Joel Shew, - 650

'; by W. P. Hort, 472, 567
" Gardner's history of, 98
Military surgery, by prof. Flint, 676
Mitchell, T. D. on yellow fever in

Philadelphia, - - 717

Morphine in typhoid fever, 95
" in hernia, by Dr. Doman, 96
Mortality in U! S. Navy, by A.

Hester, .... 705
Mosse, Dr., on yeast in boils, 513
Mucus in infants, by M. Valleix, 521
Naevis maternis, by R. Riley, 431
Nasal hemorrhage, arrest of, 424
Natchez, a residence for consump-
tive invalids, 23
" health of, - - - 266.
Natural philosophy, hand book of, 805
Negro constitution, Dr. Cartwright

on philosophy of the, 195
" diseases of the, by Dr.Grier, 752
Neuralgia, atropine in, - 266
Neuralgic amaurosis, - 37&
New works, reviews of, 98,246,386
Norwood, W. C, on veratrum

viride, - - 141, 600

Nostrils, inflammation of, by J. H.

Douglas, - - - 604

Nott, J. C, on the geographical

distribution of animals and men, 727
Nye, A. R., on arsenic in hooping

cough, ... 282
Obesity, iodine a cure for, 398
Obstetrics, by C. D. Meigs, 253

I N I) E X.

vii

Ocean Springs, Miss. - 706

Oil of savine as an emenagogue, 689
Opium taking, by W. M. Boling, 750
Orchitis, collodion in, - 788

Os humeri, dislocation of the, by

prof. Eve, - - 580

Osteo-aneurism,by Dr. Carnochan,824
Paris, letters from, - - 409

Passional hygiene, by Dr. Lazarus,808
Patton, A., on typhoid fever, 560
Patient his own surgeon, - 849
Pathology, by John Simon, 545
" of heart, by Dr. McDowell ,774
Percussion and sound,by Dr. Flint,680
Pericarditis, by Dr. Ormerod, 697
Phlegmasia dolens, by Dr. Winn, 523
Physiologv, by Dr. Carpenter, 669
" " by Dr. B. Dowler, 58
« by Dr. Reese, 105
Physiological researches, by M.

Bernard, s - - 370

Pneumonia, by G. Zimmerman, 782
" chloroform in treatment of, 837
Poison of strychnine, camphor in, 527
" sale of, - 115
Poisoning from chloroform, 528
" from fungi, - 634
Polypi, by Horace Green, 261
Pope, Dr., address to graduates by, 98
Practice of medicine, by Dr. Wood,259
Pregnant women, influence of will

on, J. G. Braman, - 362

Professional aphorisms, - 628
Provisional callus, by Hamilton, 819
Puerperal vulvitis,by M.Chavanne,522
" convulsions, by Dr. Malone, 594
« " by A. Bolton, - 788
Purgatives in fever, by Dr. Armor, 622
Pye, E. A., on opium in tetanus, 436
Quinine in intermittent fever, ] 40
" in continued fever, - 1
" in urticaria, - - 93
" in continued fever, - 255
" and opium in paroxysmal fev. 555
" effects on pulse,by Dr.Boling, 746
" in typ. fever,by R.L.Scruggs, 765
" adulteration of, by Dr. Moll, 783
Recamier, M., death of, • 402
Rectum, accumulations in, - 271
Respiration in man, by Dr.Draper, 93
" artificial, by A. W. Ely, 209
Rheumatism, aconite a remedy for,689
" cauterization of the ear for, 397
" acute, by Dr. Maxson, 838
Riddell, J. L., on organic cells, 458
" on microscopic observa-
tion, - 116, 173

Riddell, J. L., on botany, - 609
Riley, R.; on naevis maternis, 471
Sacrum, luxation of, - 649

Scruggs, R. L. clinical notes, 2 6
" on cod liver oil in tuber-
cular affections, - 583
" on quinine in typhoid fever,765
Scirrhous, extirpation of, 233
Scurvy, potash in treatment of the, 684
Shanks, prof., on mortuary statis-
tics of Memphis, - 12
Skin, diseases of, by Dr.Nelligan, 548
Sore throat, by prof. Merrill, 148
Spina bifida, by W. Taylor, 314
Spinal cord, by Brown-Sequard, 550
Spleen, rupture of, by A. Hester, 278
" functions of, by Dr. Bennett, 684
Springs, mineral, - - 552
Stomach, cancer of, by VV. Wilson, 339
Strychnine, spasm cured by, 839
Surgery, by W. Fergusson, 825
principles of, - 102
" manual of, - - 103
" lectures on, - 218
384

" principles of, - 254

" operative, - - 657

." and anatomy, - 812

Sydenham, works of, - 260

Syphilis, constitutional, and here-
ditary, by E. Wilson 535
" " iodide of sodium a

cure for, - 840
" letters on, - 657

" treatment of, - 363

Syria, medicine in, - 523

Tape worm, kousso in treatment

of, by Dr. Frydinger, - 135
Taylor, W., on cholera in Cali-
fornia, - - 53
" on spina bifida, - 314
" R. F. on cerebro-spinal

meningitis, - 184
Tetanus, opium in the treatment

of, by E. A. Pye, - 436
" cyanuret of potassium

in, - 86,424

" practical observations on,

by Dr. Fugate, - i93
" by J. Graham, - 793
Thoracic disease, iodide of pot-
ash in, * - - 846
Tracheotomy, performed with suc-
cess by Dr. Foster. - 701
Trismus nascentium, * 845
Tubercles in the lungs, how

formed, - - - 267

viii

INDEX*

Tubercular consumption, specula-
tions on. - 640

Ulcers, tincture of cantharides in
treatment of, - - 365

University of Louisiana,

128, 426, 850

Urinary calculus, on the, by prof.
Eve,* - - 124

Urine, on the chemistry and pa-
thology of, - - 789

Urticaria, quinine in, by Doctor
Wickham. - - 93

Uterine hemorrhage, pressure in, 114

Uterus, rupture peritoneal coat of,
by R. Lee, - - 526

Uterus, double, case of, by D.
Macgibbon, - - 129

Vaccine virus, - - 565

Vagina, rupture of, by M. Dan-

yau, - - 236

Valleix, Dr., on the obstructing

mucus of children, - 521

Variola, modification of, by R.
Fowler, - * 240

j Varicocele, gutta percha in treat*

ment of, by Dr. Carey, 272
j Varicose aneurism, new mode of
J operating in, by M. Malgaigne, 522
Venereal chancre, acetic acid as

an application to, - 398

Veratrum viride, by W. C. Nor-
wood, - - - 141,600
Water, topical uses of in surgery,

by C. A. Pope, - - 801

Webster, D., last illness of, 681
Wellington^ Duke, medical treat-
ment of, - - 629
Wharton, G. M., on carbuncle, 598
Widows and orphans of medical

men, society for relief of, 627
Will, effects of, on pregnant wo-
men, by J. G. Bramar, - 362
Winn, Dr., on phlegmasia dolens,

occurring after parturition, 525
Yeast, use of, in treatment of

boils, by Dr. Moss, - 513

Volume, end of, - - 845
" contributors to, - 862

THE NEW-ORLEANS

MEDICAL AID SURGICAL JOURNAL.

JULY, 1852.

part first,

ORIGINAL COMMUNICATIONS.

L—ON THE USE OF QUININE IN CONTINUED FEVER.

BY WM. M. BOLING, M. D.. MONTGOMERY, ALA.

There is considerable diversity of opinion among Southern Physi-
cians as to the effect of Quinine in Continued Fever, more especially
in Typhoid Fever, which, within the few years past, has appeared to
spread itself from the points in which it would seem to have been long
known, into others in which it had been but rarely seen. One writer,
for instance, R. F. Gibbs, M. D., of De Soto Parish, Louisiana, in the
2d volume of Fenner's Southern Reports, speaking of Typhoid Fever,
remarks—-" From the mixed nature of many of the cases which came
under treatment, and the decided periodicity, I was reluctantly im-
pressed with the idea that Quinine would prove a valuable adjuvant in
its early stages ; but after repeated trials, in doses large and small, I
was forced finally to abandon it entirely, as not only useless in every
case, but in many cases decidedly prejudicial to the patient." A similar
opinion we find frequently expressed by others.

On the other hand, Dr. Thomas Fearn, of Huntsville, Ala., speaking
also in the 2d volume of Fenner's Southern Reports, of a continued
fever which he calls Typhus, — the symptoms of which, so far as they
are given, correspond very well with those of the fever now known
among us as Typhoid Fever,— -claims to have obtained much benefit in

The New-Orleans Medical and Surgical Journal,

it, from the use of Quinine ; nay, even to have arrested its progress —
to have at once cut it short in its course. He gave to an adult female
three doses of 20 grains each, at intervals of one hour.

For three or four years past, Typhoid Fever has prevailed in Mont-
gomery, so that at no time, perhaps, or at least but for short intervals
in that period, has it been entirely absent from the place. My experi-
ence with the remedy in question, in the disease during that time, would
lead me to a different conclusion from either of the above — one holding,
as it were, a medium between them.

In a very few cases of Typhoid Fever under my treatment, I think I
have seen an unfavorable effect produced by Quinine, apparently
through a local action on the gastro-intestinal mucous membrane —
augmenting the already existing irritation of this part. In a still smaller
proportion of cases, I have thought its influence, — not apparently ex-
erted in the manner just mentioned, — upon the nervous system, has
been unfavorable. Sometimes it has apparently produced neither a
favorable nor an unfavorable effect, while often its influence has been
decidedly beneficial.

In some cases the disease, as it appears with us, presents somewhat
of an acerbative character ; more so, it is probable, than at the North.
In such cases, frequently, though not invariably, Quinine given in pretty
full doses, will control entirely, or greatly diminish the violence of the
exacerbations, and in that event, as may readily be understood, its in-
fluence upon the progress of the case will generally be favorable ; and
I have seen it thus beneficial.

In cases in which the febrile excitement has been running high the

pulse frequent, the skin hot and dry, and the tongue parched and pointed,
— with such doses of the remedy as I have ventured to give, I have
sometimes succeeded in subduing the high excitement, — reducing the
pulse perhaps from 120 or 130, to 90 or 100, — diminishing the heat of
the surface, rendering it, indeed, as also the tongue, moist, and the
patient's feelings and condition generally altogether more "comfortable;
— and this improved condition I have seen maintained for days, under
the continuance of the remedy. Invariably, however, (with exceptions
hereafter to be noticed, where there was reason to believe that a favor-
able crisis took place independently of the effects of the remedy during
ihe time of its administration) the febrile symptoms have returned on
■the suspension of the Quinine, and the disease has passed on through
its course, apparently unaffected by the temporary interruption, in part,
of its progress ; as if, though the remedy had exerted its usual con-

Dr. Boling on Quinine in Continued Fever.

^rolling influence over the heart and arteries, while continued, it was
totally without power or efficacy to neutralize permanently, or effect
the elimination of the poison or particular cause of the disease from the
system.

It is still remembered by several at least of the Physicians of Mont-
gomery, if not indeed by all of them, how much, after Typhoid Fever
became a prevalent disease among us, the friends of patients laboring
under it, seemed surprised that their Physicians, whom they had so
often seen on previous occasions arrest with so much certainty, often in
a day or two, the severest forms of miasmatic fevers, could not succeed
in "breaking," as they expressed it, the very slight degree of fever,
which, in many instances, was present, in attacks of the former disease
in a shorter time than two, three, four or five weeks, or longer; and
the dissatisfaction, often expressed in words, or manifested by the
countenance, was a source occasionally of no slight mortification. The
Physicians of Montgomery had been in the habit of using Quinine very
freely, and with great success. Their patients were accustomed to see-
ing them arrest with it the worst forms of miasmatic fevers, as if with
talismanic promptness and certainty, and they could not understand
why even slight febrile attacks should be allowed to run on for weeks.
It is not probable, then, that the remedy failed to have a fair trial
among us, accustomed to the use of it as we had been, and goaded as
we were by the friends of the sick to " break up" the fever. They
understand these things better now, and bear patiently the tedious
attendance of their Physicians, while the disease "drags its slow length
along.''

It is true, that in one or two instances, in which I barely suspected
the possibility of a commencing attack of Typhoid Fever — the existing
symptoms being much such as might be present in many forms of slight
indisposition — and certainly not conclusively characteristic of the fever
in question, — I have succeeded in arresting permanently the progress
of the disease, or preventing the attack, if one was really threatened,
by a full dose or two of Quinine. It is more than probable that if the
Quinine were given about the time at which the disease was reaching
its crisis, the febrile phenomena subdued by it for the time, would not
be rekindled on its withdrawal, and the delusion might thus be induced?
that the disease had actually been cut short by the remedy. Moreover,
in several mild cases, in which I have given the Quinine on the 14th,
and in one about the 21st day of the fever, the favorable crisis which
then occurred, has seemed more decided or marked, than in any cases
in which I have not used it, at about the period of the natural termina-

The New-Orleans Medical and Surgical Journal.

tion. I judge that in the instances referred to, a favorable change may
have been about to take place naturally, — in part from an amelioration
of some of the symptoms prior to the administration of the Quinine, but
more, because in these very cases, the remedy, tried at an earlier period,
had failed to arrest their progress. In other cases, too, in which I have
given it at certain septenary periods, but when probably no tendency
at such particular times to a favorable change existed, the periods have
passed without a forced crisis being produced by the Quinine. It is
proper here by way of explanation to remark, that oftener than other-
wise under my observation, as others have found to be the case also,
the change for the better has occurred about the 14th, 21st, or 28th,
day, and so on, whenever the date of the attack could be ascer-
tained.

But, though in no case of Typhoid Fever, at least in none after the
disease was well characterized, so that its presence could with any
reasonable degree of certainty be asserted, have I been able to cut short
the malady, unless the cases just referred to may be deemed instances
in point, still I claim that much advantage may in many eases be de-
rived from even the temporary subdual or control of the febrile action
above alluded to $ indeed, under certain circumstances, we might even
find it beneficial thus to moderate the violence of the fever, by adequate
doses, till it should have reached its natural termination. In this way
may we not only render the patient's condition much more Comfortable,
by diminishing headache, thirst, and the unpleasant feelings of malaise
connected with the higher grade of febrile action, but even exert a.
favorable influence as regards the ultimate result, by preventing the
development of various inflammatory complications, which might and
probably would grow out of it.

But although I have never my self been able to cut short by the use of
Quinine, an unquestionable case of Typhoid Fever, and although it is
now, I believe, pretty generally the impression among such Physicians
of this section of Alabama as I have conversed with on the subject, that
it cannot be so arrested, it is more, whatever my own belief, than I
would be willing to assert, that it may not be done. I have never my-
self given the remedy in Typhoid Fever to the extent indeed that Dr.
Fearn did, in the cases in which he succeeded with its use, though I
have frequently given it in mild cases without this effect, in doses, with
which I am in the habit daily of arresting with certainty and at once
the most violent attacks of the various forms of miasmatic fever. Either
then my doses have been too small, or the disease now called Typhoid
Fever among us, is different from the cases which were treated with

Dr. Boling on Quinine in Continued Fever.

Quinine successfully by Dr. Fearn, and which he calls Typhus, not-
withstanding the striking resemblance between them, — and at all events,
in both there is this agreement, that in their symptomology they differ
widely from any of our recognized shades of miasmatic fever. Be-
sides the name of Typhus which he gives his eases, Dr. Fearn speaks
of the disease as continued fever. He does not speak, however, of the
post mortem appearances, and notwithstanding the resemblance, I am
forced to the belief; that the disease in question was not the one now
known among us as Typhoid Fever. I cannot think it possible that
this malady, when established in a recognizable form, can be cut short
by Quinine. With great partiality for the remedy, and not a little con-
fidence of success, based upon a long and satisfactory use of it in many
other diseases, I commenced its administration in Typhoid Fever, and
was not less astonished than mortified at the result. Reflecting upon
the probable cause of my failure to cut short the disease in its progress,
by a remedy from which I expected so much, notwithstanding that i
could temporarily control the febrile action, it occurred to me that it
might be owing to an inherent tardiness of the reparative process, in
the lesion of the intestinal glands. With the view, consequently, of
preventing, if possible, this intestinal lesion, by arresting in its incipi-
ency the fever, the very early administration of Quinine became a
main point in the treatment of the disease with me, till, I think, the
experiment was fairly tried.

I have given Quinine in Typhoid Fever, in its various stages, but
without observing any difference in its effects, in any way connected
with, or growing out of, the period to which the case had extended. 1
have given it in some cases as soon as the nature of the case was man-
ifest, and in others, at various periods to the termination of the fourth,
fifth or sixth week, and still the effect has been the same. I have given
it, too, at so early a period, that no one, from the symptoms, could say
whether the case was or was not one of Typhoid Fever, and yet the
character of the case has been developed and declared after its suspen-
sion, and the disease has pursued its ordinary course. Possible excep-
tions have been mentioned.

As to my doses — in one case I gave twenty grains, repeating it in
two hours, and thirty-six grains daily for the two or three succeeding
days, in three doses of twelve grains each, at intervals of two hours ;
always between midnight and day, supposing that the febrile action
would be less at this time. In other cases, I have given daily say two
doses of 16 grains each, or three doses of 12 grains each, at short in-
tervals, repeated for several days in succession ; and again I have kept

6 The New-Orleans Medical and Surgical Journal.

up its continuous operation by doses of 8 or 10 grains, repeated every
six or eight hours for several days ; and always the result has been
much the same. Nor have I neglected any adjuvant measures with
which I was acquainted, calculated to secure its beneficial influence.
I have given it in combination with full doses of Morphia, and I have
given it without; I have preceded its administration, where the state of
the bowels would admit of it, with small doses of blue mass ; I have
used the warm foot bath and warm drinks ; I have used tepid or cold
ablution of the entire surface, and cold drinks.

A similar mitigation of its febrile action to that which I have spoken
of as produced in Typhoid Fever by the use of Quinine, I have not only
seen produced by it in the various phlegmasia,* as we ordinarily meet
them here, but also in severe cases of organic disease of a necessarily
fatal character, in which it was merely used as a palliative, to keep in
subjection, with the attendant fever, various unpleasant symptoms,
seemingly arising from, or aggravated by it. 1 will mention a single
case in point.

In May, 1847, J. Luther, a carpenter by trade, had a severe attack
of pleuro-pneumonia. He quit bed and commenced work before he
had entirely recovered ; relapsed several times, and each time pursued
the same course, till his health became permanently impaired, and tu-
bercles were developed in the lungs. He finally took his bed on the
10th of September, and died about the middle of November. During
this confinement, besides the tubercles contained in the lungs, the right
side of the chest contained, in considerable quantity, both air and wa-
ter. Some four or five weeks before his death, the fever assumed so
much the Typhoid character, that thinking it not improbable that Ty-
phoid Fever had supervened upon his other maladies, I looked forward
to find in the post mortem examination the ordinary anatomical lesions
of this disease. It was not, however, present, in a characteristic form.
As to the condition of fever, however— The pulse was corded, varying
from 110 to 120 — the temporals throbbed— the heat of skin was great,
the tongue dry, red at the edges and tremulous, and there was constant
delirium. For some two weeks of the time, by the moderate use of
Quinine — six grains every four or six hours — the fever was kept greatly
subdued ; the pulse at from 80 to 90, the skin and tongue moist, and
the thirst, delirium, subsultus, &c, greatly diminished. Twice the Qui-
nine was omitted, and the fever, with the attendant phenomena, such as
delirium, dec, returned with the former violence. While kept under

* American Journal of Medical Sciences lor July, 1844, page 87.

Dr. Boling on Quinine in Continued Fever,

the influence of Quinine, in every respect his condition was decidedly
more comfortable than when the remedy was omitted.

Dr. Fenner, in commenting on the cases of Dr. Fearn, gives it as his
belief, that the opinion, adverse to the use of Quinine in the Typhoid
Fever of the South, pretty generally of late expressed, has been too has-
tily pronounced ; and believing himself that it " is one of the protean
forms of endemic malarial fevers," he would expect Quinine, if properly
administered, to cure it. He moreover intimates, that the failure must
be owing to a lack of knowledge of the proper use, and method of ad-
ministration. Dr. Fenner, however, does not give us the details of any
cases, which he himself has succeeded in cutting short by the use of
Quinine, nor does he even tell us that he has thus cured a single case.
Although in the most violent and even complicated cases of the various
shades of misasmatic diseases, I, as also members of my professional
brethren, administer the Sulphate of Quinine in the quantity generally
of from 24 to 40 grains, in two or more portions, perhaps repeated the
next day, with the utmost confidence that in a vast major ity, the disease
will be at once arrested in its progress, I have several times failed, in
cases of Typhoid Fever, of so mild a character, as to leave it almost
questionable whether fever existed at all or not, to produce any
thing more than a temporary mitigation of the morbid phenomena, by
the remedy in the same dose, and administered, too, in conjunction with
all such adjuvant measures as have seemed to me to conduce to its fa-
vorable operation under other circumstances. I have used it with this
result in cases in which there was scarcely an appreciable increase of
temperature of the surface, — the pulse not exceeding 90 — no delirium
—but little thirst — tongue but slightly dry and tremulous — but the
slightest tympanitis — and the evacuations, though liquid, not perhaps
exceeding one or two in the 24 hours. Such facts do not seem favora-
able to Dr. Fenner's views of the identity of the diseases.

It is true, Dr. Fenner tells us, that his experience with Typhoid Fe-
vor " has been too limited to entitle him to speak authoritatively on the
subject," while he suggests or asserts, that in it, " Quinine, in large
closes, must be given in the forming stage of the fever, or it had better
be withheld altogether. *****
If the practitioner is not sufficiently familiar with the action of Quinine
in large doses, to venture on from 20 to 30 grains, in combination with
one or two grains of Opium, and perhaps ten of Calomel or Blue Mass,
at one dose, and within two or three days of the attack, we would ad-
vise him not to tamper with this remedy at all," etc. I am inclined to
think that Dr. Fenner does not differ much more from the profession

§ The New-Orleans Medical and Surgical Journal.

generally, in his opinion that Typhoid Fever may be cut short and per-
manently arrested in its course by Quinine, than he does in his recom-
mendation of Calomel in this malady, as a general practice, in the dose
of ten grains. Judging from my own experience with the disease, as
it has prevailed here for the last few years, I would say, that few cases
indeed occur, in which a single ten grain dose of Calomel would not
exert a prejudicial influence ; and that administered generally, it would
have the effect of increasing the mortality at least three or four per
cent.

Every one interested particularly in the subject, who reads the re-
marks of Dr. Fenner, must regret that he did not give the grounds upon
which his conclusion is predicated, that (believing, as he does, that
Quinine will cut short Typhoid Fever) it must be given in the " form-
ing stage" — " within the first two days, or three at farthest, from the
time the fever is perceived." We are led to infer that it is not based
upon his own actual observation. It would seem inconsistent, too, with
his belief in the connection or relationship of Typhoid Fever with the
" protean forms of endemic malarious fever ;" because not even in the
very worst forms of these would Dr. Fenner restrict the administration
of Quinine to the first three days, but with the utmost confidence of
immediate success, would resort to it in most of them at a much later
period. It cannot, either, be upon Dr. Fearn's report, for in the only
case given at all in detail, — that of Miss Julia Scruggs, — -it was not
till on the fourth day after Dr. Fearn's examination that the Quinine
was administered, and from the very slow and insidious manner in
which the disease seems to have been developed, it is not improbable
that fever may have existed for several days prior to the examination,
especially when we take into account the very decided character of the
symptoms which were then presented.

II.—PRESENT HYGIENIC CONDITION OF CALIFORNIA -EPIDEMIC
ERYSIPELAS — MEASLES — SMALL POX AND VARIOLOID—
PREVALENCE OF INSANITY— INUNDATION OF SACRA-
MENTO, etc.*

BY THOMAS M. LOGAN, M. D., OF SACRAMENTO.

I resume our correspondence at a new epoch in the medical history
of our young State — an epoch, which the most impetuous current of
events that has ever borne humanity onwards, has effected. A year

*This letter was written for Fenner's South. Medical Reports. (Ed.)

Dr. Logan on the Hygienic Condition of California.

has sufficed to do the work of a century, and California has passed
through a succession of lustrations, as thorough as they have been ex-
traordinary. The rich inheritance of life, with all its attendant and
prospective blessings, hitherto so rashly forfeited by the suicidal conduct
of the earlier immigrants, is now enjoyed by her citizens in a ratio
more than compensatory for previous calamities and sufferings ; and as
the ameliorations and comforts of civilization multiply in our midst, so
the allotted period of existence which the Creator has apportioned to his
creatures, may be as surely counted upon here, as in any, the most
civilized country on the face of the whole earth. Indeed if a strong in-
stance were wanting to confirm the well established point in vital sta-
tistics, that in proportion as a community advances in the practice of
those hygienic laws and regulations known to be necessary for the pre-
servation of the general health, so is the average term of life prolonged,
California may now, par excellence, be cited. Her bills of mortality
compare favorably with those of the most salubrious countries, and the
pestilential territory of a year ago is now the brilliant compeer of her
transmontane sister States, in all that contributes to the comfort and
preservation of the life of man.

During this transition stage, I have in previous letters endeavored to
snatch from oblivion, and preserve for future comparative reference, the
salient points of interest to the medical philosopher, and now proceed
to subjoin a few remarks, in continuance of my observations on the
diseases of California.

Although acclimation, good food, comfortable lodgings and an im-
proved state of morals, render us less liable to the fatal diarrhoeas and
other diseases which more than decimated the population of past years,
still, we are yet far from being exempt from the prevalency of diseases,
which depend, in a measure, upon changes that have been slowly
wrought upon the human body by past as well as existing circumstances
and conditions. The predisposition to blood diseases, induced by cli-
matic and other causes, discussed in my last letter on the Scurvy, still
persists ; for I can only regard the cutaneous disorders that now prevail
as so many symptoms distinctive of the character of the new morbid
impression ingrafted upon the system. This is a bold assumption, sa-
voring of the old fashioned humoral pathology, but nevertheless sustain-
able upon the sure basis of organic chemistry, applied according to
Liebig's doctrines. By a sort of process of fermentation, the morbid
matter in the blood is brought sooner or later into a state in which it , is
ready for expulsion from the body, and the peculiar eruption — the
symptom of the diseased action — is the mode by which it is thrown off,

The New-Orleans Medical and Surgical Journal.

But I have taken up my pen to chronicle facts, and not to indulge in
speculations.

In Nevada and the mountain districts, epidemic Erysipelas prevailed
at one time with alarming severity, and many fell victims in the course
of a few days from its invasion, to its metastatic action on the brain.
Its leading features were a slight tonsilitis, tenderness of the lining
membrane of the nose, and ultimately the characteristic inflammation
of more or less of the face, spreading downwards in some cases to the
neck, shoulders and breast ; and sometimes dipping through the skin,
and affecting the subcutaneous areolar tissue. In some severe cases
the parotid and cervical glands became inflamed, and then and there
suppuration set in, and abscesses formed in the cellular tissue in which
they were imbedded. The majority of deaths, however, occurred in
consequence of the extension of the inflammation to the pulmonary or-
gans.

In Sacramento I have found the affection to be quite manageable ;
although sometimes erratic in its course, it was generally delitescent. I
believe the fatality in the country may be assignable to an inapprehen-
sion of the true epidemic constitution of the season. You, in New Or-
leans, know how dangerous it is to apply indiscriminately in one epi.
demic the remedies that may have been useful in another, especially in
a different locality. At one time and in one place inflammatory symp-
toms may run high ; at another time or in another place, there is an
early tendency to debility and sinking.

During the prevalence of the erysipelatous affection here, typhoid symp-
toms were easily discernible ; as manifested by a feeble and frequent
pulse,and sometimes a dry, brown tongue. These symptoms were always
aggravated by blood-letting or active catharsis. The notion of most of
our American practitioners about cutting short the disease, by what is
called active, energetic treatment, is erroneous, for generally it termi-
nated sooner or later by resolution, whether treated or not, provided
the treatment was not too perturbating. It does not follow from this
that no interference whatever was called for on the part of the Physi-
cian ; but rather an active non-interference; not with the expectation
of curing the disorder, but of conducting it safely to its termination.

Sydenham informs us that Measles of an unusually bad kind prevailed
in London in 1670 and '74, the very same years in which Small-pox
was epidemic. Now this observation, from such high authority, is not
only corroborated by the present medical condition of California, but
also illustrates what I have before remarked ; for the simultaneous
prevalence of several eruptive disorders surely testify to some change

Dr. Logan on the Hygienic Condition of California. 1 1

previously produced in the human body by the gradual influence of cer-
tain predisposing causes.

During the last six months Erysipelas, Rubeola, Variola and Vario-
loid have been prevailing and modifying each other in the most remark-
able manner. Indeed so intimate has been the blending of these three
latter eruptive fevers, that it has often at times been impossible to say,
even for the first hours after the eruption began to appear, which of
the disorders predominated. All three were ushered in by rigors, with
flushing, gastric distress and fever. All three were liable to have their
more open features marked by violent congestions. In all three typhoid
depressions and complications, attended with change in the color and
other characteristics of the eruption. If such, therefore, was the diffi-
culty in discriminating between these disorders, you may readily infer
that there was but little indication for varying the treatment. As far
as my experience goes, the problem whether active treatment in the
first or second stage of an exanthem will contribute to mitigate subse-
quent symptoms, is completely solved ; for the worst cases of Measles
or Small-pox, I saw or heard of, were those in which bleeding and
purgation were resorted to, in the early stages, with the view of strang-
ling the disease.

As regards the disposition to other diseases induced by the climate
of California, I would add Insanity to the category. The majority of
the population being from the Northern States and other colder coun-
tries, are sensibly affected by the long, torrid heat of the summer's sun,
to which, from the nature of their occupation in California, they are
peculiarly exposed. In this way the nervous susceptibility is greatly
exalted, and a predisposition to mania and head affections is created.
From a report which has been submitted to the Legislature by the Phy-
sician of the State Hospital, it appears that in eight months 44 lunatics
have been received into that institution. This, it would seem, is more
than accrues in any other State of the Union within the same period,
however the difference in population. " If," says the report, " in a
population of 200,000, there are fifty lunatics in one year, and it being
but reasonable to suppose that in one or more this population will in-
crease nearly double, it must strike us all that the number of lunatics
in a few years will have accumulated to an astonishing number."
Among the exciting causes assignable for the prevalence and increase
of this, the most deplorable affliction to which man is heir, may be
reckoned the shock of disappointment and suffering, unmitigated by
the sympathy of friends, or woman's soothing influence, to be met and
overcome by those who have come here buoyant with golden dreams.

The New-Orleans Medical and Surgical Journal.

The speculative and gambling spirit, too, which pervades the whole
community, more or less, the sudden transitions from wealth to poverty,
from temperance to excess — the bitter consciousness of blighted
schemes, to which the brightest hopes were attached — these, and a va-
riety of other influences, throw into confusion the finely balanced pro-
perties of mind, and dethrone reason from her seat. At the present ra-
tio of increase, the necessity of an Asylum, where the unfortunate sub-
jects of this malady may receive the benefits of scientific treatment, is
imperiously called for, and it is to be hoped that our Legislature will
effect that which every consideration of humanity and public duty de-
mands at their hands.

I have thus drawn up a hasty sketch of all that has occurred of in-
terest, in a medical view, since my last letter, and which the present
calamitous inundation of our city, by interrupting all business, and con-
fining us to the upper stories of our dwellings, has afforded me a little
philosophic leisure to accomplish, although imperfectly.

In aprevions letter I mentioned that Sacramento City resembled
New Orleans in being located on an alluvium, subject to the annual
overflow of the river banks. Our city, however, is more precariously
situated, for being built in an angle, where the Rio de los Americanos
flows into the Sacramento, we have two riversito guard against. When
the mountain torrents, caused by the melting snow, swells the one, the
other, which empties into the Sacramento, having no vent, overruns its
banks, and floods the whole valley, as has just occurred. It was sup-
posed that sufficient protection had been provided against inundation
by the throwing up of a levee ; this, however, has proved inadequete*
I shall watch the effect of this submersion of our city and the surround-
ing country upon the general health, and at some future day give you
the result of my observations,

III. — REPORT OF THE MORTUARY STATISTICS OF MEMPHIS,
TENN., FOR 1851.

Made by a Committee appointed by the Medical Society.

COMMUNICATED BY PROF. SHANKS.

At a meeting of the Memphis Medical Society, held March 17, 1852,
on motion of Dr. Shanks, [President of the Board of Health] the quar-
terly reports upon the diseases and mortuary statistics of the city, for

Dr. Shanks on the Mortuary Statistics of Memphis, Tenn. 13

the past pear, made to the Society, were referred to Drs. L. Shanks, W.
V. Taylor and John Pitman — a committee, to digest from them a re-
port, to be forwarded to the Board of Health of the city of New Orleans,
in compliance with a request made last year, that all interesting infor-
mation on these subjects should be reciprocally communicated.

In the discharge of this duty the following report is respectfully
transmitted to the Secretary of the Board of Health for the city of New
Orleans, by the above committee, its defects and incompleteness will
be obvious ; but the want of fall and complete data must be accepted as
their apology for its imperfections.

Mortality in the City of Memphis, for the year 1851.
With a Classification of the Diseases,
(Prepared from the Records of the Board of Health.)

Diseases.

Jan.

Feb.

March

j April

| May.

H
Z
D

j July.

Aug.

Oct.

Nov.

Dec.

Total.

Cholera.

Diarrhoea

Dysentery

Choi. Infant.

OTHER DISEASES.

Digestive Syst.

Nervous do.

Respirat. do.

Generative do.

Fever remit.

Do. conges

Do. typhoid

Do. scarlet

Smoll Pox

Dropsy

Cancer

Disease, Heart

Erysipelas

Chickenpox

Exter causes.

Old Age

Not specified

197

146

717

Number of Deaths under 5 years - - 208

" " " between 5 " & 20 - - 51

" " " 20 « & 40 - - 195

" " above 40 " - - 100

554

Ages not specified - - 163

717 Total.

Note. The Hospital is a State Institution— is out of the City limits— the
deaths there are not reported to the Board of Health, and therefore are not embra-
ced in the above table.

The New-Orleans Medical and Surgical Journal,

The table showing the mortality for each month, and the aggregate
mortality for the year 1851 in the city of Memphis, presents a large
number of deaths for the year; the greatest mortality, in proportion to
the population, that has occurred in the past 15 years.

Various obvious causes co-operated in producing this unprecedented
mortality, which it is important to consider, that their results may be
understood and properly appreciated, as they may never occur again,
either separately or conjointly, with the same malignity.,

Preliminary to a brief general and special account of these peculiar
causes, and of the diseases produced by them during the past year, it is
proper to furnish some statistical proofs of the statement already made,
that the year 1851 was unprecedented for its mortality here.

The last census shows that the city proper contained then a popula-
tion of 8840—6369 whites, and 2471 blacks. The suburbs a probable
population of 3000. The same returns made the aggregate deaths for
the year ending June 1st, 1850, amount to 354. This period embraces
the most fatal prevalence of Cholera, as an epidemic, in the months of
June and July. Notwithstanding the mortality from Cholera, however,
the number of deaths during the year only amounted to about 3 percent
of the population of the city and suburbs. The suburbs are properly
included, as the city sextons performed their burials and reported their
interments.

To this aggregate population proper, additional allowances, also,
should be made, for the large proportional number of persons put off
from steamboats at this point, incurably sick, or dead, for interment;
This item would be equal to half per cent of the above mortality,
which would reduce the per centage of the year, from the 1st of June,
1849, to June, 1850, to about two and a half per cent. This period is
selected, as the census and returns were made by the officer appointed
under the act of Congress, and should be regarded as impartial and re-
liable.

The following is a brief account of the general character of the wea-
ther, and the peculiar local conditions in and around the city, and of the
prominent causes of the diseases and deaths during the year.

January was mild and pleasant until towards its close ; the thermo-
meter sunk down as low as 17 ° — the extreme of cold for the month.
A few cases of Small-pox, and scattering cases of Typhoid Fever oc-
curred, but no epidemic prevailed. The uumber of deaths were 22 for
the month, and the table shows they were produced from the ordinary
diseases of winter.

Dr. Shanks on the Mortuary Statistics of Memphis, Tenn. 15

February was mild. The thermometer at 9, A. M., on the 16th,
sunk to 28 ° — the only time during the month, at that hour below the
freezing point. Frequent rains occurred ; the aggregate quantity was
8.77 inches. No epidemic prevailed. The number of deaths
were 26.

March was mild and free from variations in the weather. The mean
temperature was 55 ° . Five showers of rain, making a fraction over
two inches, occurred. No epidemic prevailed. Bronchitis and Pneu-
monia were the most common and fatal forms of diseases. Consump-
tion swelled the number from diseases of the respiratory system. The
whole number for the month was 37.

April was mild, with occasional showers the first eight or ten days ;
then a cold spell, with frost for several days ; the remainder of the
month was pleasant. The mean temperature 55 ° ; quantity of rain, a
fraction over 2 inches. Diseases of the respiratory system were most
common. Hooping-cough prevailed. The last of the month one death
occurred from Cholera. The total number of deaths during the
month, 35.

May was generally clear and dry, and pleasantly warm. Mean tem-
perature 70 ° . Eight showers of rain making 2.83 inches. The lat-
ter part of the month the most protracted drought commenced known
to the oldest citizens. Though it was general in the Southern country,
many sections had the benefit of occasional light showers of rain, to
cool the atmosphere and moisten the dust, but these occasional refresh-
ing and healthful showers were almost«entirely withheld from Memphis
until the latter part of December. During this month 24 deaths are
registered from Cholera, 11 from other diseases of the digestive system,
and 4 from Fever. Intermittent and Remittent Fevers were more pre-
valent than usual. Cholera commenced in families who had not been
exposed to the disease in 1849 ; having emigrated here from the inte-
rior of Mississippi but a few months before the disease commenced
among them. They were otherwise rendered more susceptible to the
disease from want of proper accommodations, and the imprudent use of
crude vegetables and fish. Fatal cases had occurred at various places
along the river below, and several deaths on the opposite bank, before
it commenced here. No direct communication between the first case
here, and cases of the disease elsewhere, could be traced, except the
fact that a man who came a short time previously from Arkansas, had
died of a disease described as being like Cholera, in the house to which
the family moved immediately afterwards, among whom the disease

16 Hie New -Orleans Medical and Surgical Journal.

first commenced, and spread amongst them, their friends and visitors.
In a few days, however, cases occurred in various and remote parts of
the city, without any probable or satisfactory evidence of direct commu-
nication with the disease. In this respect the occurrence of Cholera
here in May, 1851, was very different from its commencement here in
December and January of 1848 and 1849. Then all the first cases,
until the disease had benome general, could be traced to near contact
with other cases from a distance, or the infected boats coming from New
Orleans.

Total number of deaths for the month was 70 ; most of them from
Cholera and its complications with other diseases.

June was clear, hot and dry. Mean temperature 80 ° . Quantity
of rain less than one inch. The register shows 47 deaths from Cholera,
34 from other diseases of the digestive system, 20 of whom were from
Cholera Infantum, to which may doubtless be added a large portion of
the 32 registered — disease not specified. Of the 12 deaths from dis-
eases of the respirative system, most of them were produced by the Cho-
lera influence.

To the epidemic Cholera, the great excess of mortality of May and
June may fairly be attributed. For, although there were more cases
of Remittent Fever than usual, except when complicated by Gastro-
enteritis and congestion, produced by the epidemic Cholera, it was not
fatal. Total number of deaths for June, 145.

July was clear and regularly hot ; but few changes occurred in the
temperature of the weather, ano>but few clouds temporarily overcast the
sky. The wmd South, Southeast or Southwest. Mean temperature at
9, A. M., was 81.96; at 3, P. M., 88.74, The register shows 17
deaths from Cholera, 6 from Diarrhoea, 1 Dysentery, 12 Cholera Infan-
tum, 7 Fever, 13 diseases not specified, most of whom, probably, died
of Cholera. The total number of deaths in the month 87. Miasmatic
fevers were unusually prevalent.

August was generally clear, hot and dry, with sultry Southern winds.
A few light showers of rain during the month, making altogether 1.22
inches. Mean temperature at 9, A. M., 83.90 ; and at 3, P. M., 86.35,
This month was regularly hot and sultry, and in consequence of the
drought, the nights were peculiarly so. Malarial Fevers were very
prevalent and unusually fatal. Total number of deaths 61.

September was remarkable for the continued heat of the days and
nights ; the almost entire absence of either cloudy weather or rain*

Dr. Smacks on the Mortuary Statistics of Memphis, Tenn. 17

Only .20 inches of water fell during the month. The mean tempera-
ture at 9, A. M., was 76.30; and at 3, P. M., 85.08. The largest num-
ber of deaths were produced by the autumnal forms of fever. Total
number for the month 73.

October. During this month the weather was regularly clear and
warm. Only .85 inches of rain fell. The mean temperature at 9, A.
M., was 59.96 ; and at 3, P. M., 68.16. The large mortality for this
month was produced by bowel affections, and fevers of a congestive
form, complicated with inflammation of the digestive system. Total
number of deaths for the month 72.

November. The register of the weather for this month has been
lost, and therefore the mean temperature and the exact quantity of rain
cannot be given. The weather was, however, agreeable and pleasant,
except for the continuance of the drought, and the consequent great
annoyance and discomfort from the dust. The diseases of the respira-
tive and digestive systems produced the chief mortality. Total number
of deaths 38.

December. The mean temperature of this month was 40.45, at 9,
A. M. ; and at 3, P. M., 46.35. The quantity of rain was 4.14 inches,
which fell in the latter part of the month. It was altogether a pleasant
winter month.

Four deaths from Cholera are registered, and the remnant of Cholera
influence increased the mortality for the month. The total number of
deaths were 50.

The aggregate number of deaths for the whole year, as will be seen
from the table, is 717. Of these —

Deaths under 5 years - - 208

" between 5 " and 20 - 51
" '4 20 " and 40 - 195

" over 40 " - 100

554

Deaths from diseases not specified, 163 — 717

The census of the city has not been taken since 1849. There is,
therefore, no correct data upon which to make an estimate of the per
centage of mortality for the past year. The population has greatly in-
creased in the two years and a half since the census was taken ; still,
the aggregate of mortality for the year ending June, 1849, which was
354, when compared with that of the year 1851, which is 717, shows
an increase of mortality, greater than the proportional increase of popu-

18 The New-Orleans Medical and Surgical Journal.

lation, demonstrates the correctness of the statement already made, of
the unprecedented mortality of the past year.

Now, the true causes of this great mortality in the city, are matters
not only of great importance to her population, in reference to their re-
moval or prevention, in the future, so far as practicable ; but they con-
stitute subjects of interest to the profession at large, as facts which may
aid in throwing some light upon the subject of the causes of diseases,
and of sanitary police, when properly compared with other similar facts
and observations, showing the influence of such causes of diseases,
either singly or in conjunction, in the production of their results. The
correct and careful observation and record of certain local conditions ;
topography, heat, moisture, decomposition, &c, generally admitted to
influence the production and the malignity of diseases, afford much
more that may be made valuable and useful, than can be furnished by
theories and speculation.

The four first months of 1851 give an aggregate of 118 deaths.
These months, ordinarily, in Memphis, are nearly as fatal as the aver-
age of the year ; and notwithstanding the mortality cf April was in-
creased by Cholera, the same proportion for the other months would
only make an aggregate of 354 deaths for the whole year. This
would be more than a full ordinary amount of mortality for the city,
with its present population. The prominent causes, then, of the great
excess of mortality for the past year, must be traced, from their effects,
in the last eight months.

The first cause worthy of special notice, is the fact, that an un
usual amount of grading of streets and lots had been done during the
previous fall and winter.

Numerous, repeated and careful observations have demonstrated the
fact, that the extensive exposure of the sub-soil in the Mississippi val-
ley, which is highly vegetable in its composition, is productive of dis-
ease when acted upon by the heat and moisture of the spring and sum-
mer, in this and the more Southern latitudes.

The second cause of mortality, prominent for its effects, which ex-
tended through much of the summer, though much marked by its com-
plications with other causes, is demonstrated by its recorded fatality in
the table — viz. Cholera.

It is needless to add to the opinions and speculations, or the obser-
vations, so largely published on this subject, more than the suggestion,
that the condition of the city, from its rapid improvement, its extensive
gradings, presented a susceptibility to this specific and malignant cause
of disease, and thus greatly increased its mortality.

Dr. Shanks on the Mortuary Statistics of Memphis, Term. 19

The third cause, or causes, require more full and particular consider-
ation, for the purpose of understanding the various influences which
produced so large an amount of mortality after Cholera had subsided as
an epidemic — a great mortality, extending to the month of Decem-
ber.

These causes merit special attention, as the most reasonable and sa-
tisfactory explanation of the great difference between the mortality fol-
lowing the epidemic Cholera in June, 1849, and June, 1851. In 1849,
after the Cholera subsided early in July, the summer and fall were re-
markably healthy, and the mortality unusually small ; presenting a
striking contrast with the unprecedented fatality of the past summer and
fell.

Fifteen years of observation of the diseases of Memphis have demon-
strated the fact, that invariably when the Mississippi river has subsided
early in the summer, and there was sufficient rain afterwards to wash
off the large batture in front of the city, and to wash out the channel of
the Bayou in the suburbs ; that the dryer the weather, the more healthy
during the latter part of the summer and fall.

To understand how it was, that dry summers and falls heretofore
have been most healthy, while the last summer and fall were unprece-
dentedly dry, and attended with an amount of mortality never witnessed
here before, it is necessary that the topography of the city, and the
state of things which existed, tending to produce this unusual result,
should be considered.

In front of most of the city is a large batture, formed by deposite from
the river ; much of this is overflowed in high water. Bayou Gayoso
passes through the suburbs of the city about half a mile from the river,
running in the opposite direction, and empties into Wolf river near its
mouth, at the upper limits of the city. When the Mississippi river is
high, the back water extends up Wolf river and along the Bayou, so
as nearly to reach the Southern portion of the city. The Bayou being
thus filled, spreads out, covering the adjacent flat lands, and forms, with
Wolf river, an extensive and safe harbor for timber for all the saw mills,
for wood for city fuel, and especially for the large demand for the brick
yards located adjacent to it, on account of the great convenience
of floating timber and fuel to them from the Mississippi and Wolf
rivers.

The Mississippi river'continued high last summer until about the mid-
dle of August, and the extensive surface produced by back water in
Wolf river and the Bayou, was almost covered with rafts of timber,
for the mills, brick yards, &c. This large surface of dead water, nearly

The. New-Orleans Medical and Surgical Journal.

covered with vegetable matter, was constantly acted upon by the in-
tense heat of the sun; and when the water subsided, and deposited the
decomposing timber, and the green stagnant scum of vegetable matter,
which had formed upon its surface, they remained subject to the same
influence of intense heat, without rain enough, until the last of Decem-
ber, to agitate and partially purify the water, before it subsided, or to
wash off the channel and low grounds of the Bayou, after the over-
flow.

The batture in front of the city, over which the flaiboats laid during
the spring business season, and upon which ail the unsound and refuse
vegetable and animal matter were thrown, remained unpurified and
unwashed, after the overflow, from the want of the usual rains, present-
ing its cracked and exhaling surface, charged with decaying matter,
during the latter part of summer and fall.

The facts are obvious, from this state of things, that while the street?
and lots wTere parched, from their elevated situation, by the unprece-
dented heat and drought, that there was ample cause for the atmos-
phere, constantly loaded with dust, also to be highly charged with mal-
aria.

The river has rarely, heretofore, remained high so late; and during
the high water in former years, the dead water in the Bayou has been
agitated, and partially poured out, by frequent summer showers ; and
after it subsided, the filth and decomposable matter in the channel has
been washed out by heavy rains. In this state of things — the Bayou
washed clean, and reduced to a spring branch, which it really is, in
ordinary water in the Mississippi river — and the batture in front washed
off, and the cracks in its surface closed by heavy rains — the dryesl
weather in the summer and fall has always been the most healthy.
The cause of this, manifestly, has been the fact, that the small amount
of filth and surface of decomposable matter, not washed off, has]become
too much desiccated for decomposition, and the result is exhala-
tion.

In the past fifteen years, more cases of fever have occurred during
high water, when its surface was covered with drift and vegetable mat-
ter, and immediately after the water subsided in midsummer, than
under any other circumstances.

The past summer and fall these most efficient causes of diseases, as
demonstrated from the observations of many previous years, continued
in active operation until December.

The resuit of these co-operating causes was manifest, in the fatality
of Cholera ; in the specific cause of Cholera complicating and render-

Dr. Massie's Case of Gun-shot Wounds.

hig more fatal through the summer, the unusual amount of miasmatic
or paludal forms of disease ; and thus determining the almost unexam-
pled prevalence of miasmatic influence, to the production of congestion
and inflammation of the important vital organs, and especially the di-
gestive system — making all other diseases, by its assimilating influence,
more malignant and fatal.

IV. — I N TE R E S T 1 X G CASE OF GUN-SHOT WOUND — RECOVERY.

BY J. C MASSIE, M:. D., HOUSTON, TEXAS.

On the 26th March last, I was summoned to see the patient, Peter
Oneal, aged about 24. His constitution was good, and apparently frea
from any hereditary predisposition to disease.

On the night of the 26th, in a rencontre, he received wounds from
one of Colt's revolvers, at the distance of a few feet ; one ball passing
through the fleshy portion of the right arm, and entering the chest at
(he margin of the right mammary gland ; the other between the spine
and scapula. I saw the sufferer within an hour and a half from the
occurrence of the accident ; the attendants were compelled to keep his
body in a perpendicular position ; the whole cuticular surface was cold
and livid ; the pulse about 110 per minute, tremulous and weak. 1
attempted to ascertain the position of the balls by probing, but failed
in doing so. After having ascertained, to my satisfaction, that the ball
which entered at the right margin of the mammary gland, no longer
remained in the substance of the thoracic parieties, I refrained from
probing the wound farther, which I was satisfied, if persevered in,
would produce useless irritation in the parts, probably give rise to he-
morrhage, or to have a tendency to push the foreign body still farther
in. Consequently I dressed the wounds, and prepared to combat the
symptoms as they might arise ; the most important indication to subdue,
I knew, would be inflammation of the lungs and pleura. I was in
hopes that the extraneous body might escape spontaneously, or, if it
was small, that it might be discharged through the mouth, (as we have
authority for this) or that it might remain enclosed in a sero-cellular
sort of cyst, so as to be always retained in the same place. So soon as
reaction took place, my patient commenced spitting blood ; a consider-
able quantity was raised for r few days ; fever was almost constant for

•J 2

The New -Ode cms Medical and Surgical Journal.

seven days — sometimes very high. No cough or pain in the chest after
he ceased spitting blood ; slight paralysis of the extremities about the
eighth day, attended with considerable difficulty in urinating. This
comprehends, briefly, all the symptoms that this case at any time pre-
sented.

The treatment was the ordinary antiphlogistic means; (without the
lancet) digitalis and aconite were administered in large doses to mo-
derate the force of the circulation .; the patient was confined to a very
low diet ; he drank freely of cold mucilaginous drinks, and had his
bowels acted upon by saline purgatives and mild injections.

So far, the case presents nothing unusual in a gun-shot wound ; but
on the eleventh day he complained of violent pain in the bowels ; an
injection was ordered, and a ball, of a sugar-loaf shape, passed per
anum. The ball was flattened slightly on one side, evidently had struck
a rib, which changed the direction of its course. (I was present when
the ball passed.) Now, could it be possible that this ball could have
passed into the parieties of the chest, circumscribed the pleura, passing
through the diaphragm, and entering the stomach, without producing
extraordinary constitutional disturbance and death if it entered the stom-
ach ? However, I find a case in the American Journal of the Medical
Sciences, for 1837, where an Indian was wounded in the stomach, and
recovered. This is an anomalous case.

Some six years ago I attended a gentleman who was shot with live
buckshot in the right hypochondriac region, and in the course often days
the balls passed as in this case. My diagnosis in accounting for the
balls passing, was, if my memory serves me right, agreed to by my
distinguished friend, Dr. Gross, in a conversation with him. I con-
tended that the balls did not enter the bowel, but went with sufficient
force through the integuments, and struck the bowels with sufficient
force to deaden their vitality, but not to enter ; which contusion pro-
duced inflammation sufficient to create a deposition of lymph, which
formed a sero-cellular cyst over the ball, confining it to its place ; the
contusion gave rise to a slough, which prevents extravasation, and
enabled the parts to become united by adhesive inflammation ; in which
case, where the bowel sloughed the ball passed in, the cyst left the
bowel whole, and the then internal aperture healed by adhesive inflam-
mation. The patient recovered.

Will the same reason answer in the case of Oneal, that the ball
struck the stomach, deposition of lymph confined it to its place— the

Dr. Magoun on Natchez as a Resort for Invalids. 28

stomach sloughed, the ball fell in, and the wound healed by adhesive
inflammation.

I can find no case similar ; nor can I account for the entrance of the
ball in any other manner.

The patient recovered, and was at labor on the twenty-second
day.

V.— NATCHEZ, (MISS.,) CONSIDERED AS A WINTER RESORT OR
PERMANENT LOCATION FOR NORTHERN CONSUMPTIVE
INVALIDS.

BY C. S. MAGOUN, M. D.

Ill the December number of the Boston Medical and Surgical Jour-
nal, for 1851, will be noticed an article upon a similar subject, by W.
J. Burnet, M. D., with particular reference to Aiken, South Carolina, as
a suitable place of resort for Northern invalids, suffering from pulmo-
nary disease. Much of his reasoning is philosophical, and his deduc-
tions well founded. Yet, that a lower latitude, other things being equal,
would not be preferable, the writer is not prepared to admit.

Natchez, situated in about 31£ ° South, two degrees South of Aiken,
equally elevated, remote from sea breezes and influences, easy of ac-
cess, possessing fine accommodations, furnishing every appliance for
comfort, out or in doors, with the world to supply its market, and respond
to the demands of his stomach ; with ample moral, social, intellectual
and physical advantages, to suit the taste or disposition of any one ;
with a light pure air, a temperature modified and influenced by the cool
temperature of the Mississippi river both winter and summer, as its
vast volume of water comes from colder climes ; a never failing pure
supply of under-ground cistern water, with a uniform temperature, hardly
ever too hot or too cold — are among the advantages, as will appear by
the following tables :

Tables taken from Affleck's Almanac for 1852, compiled from the tables of the late
Dr. Henry Tooley, of this city.

Table 1st. Showing the mean monthly temperature of several years of the
coldest months.

Months.

a
ss

Mean 1
Temp. |

CD
P

Mean j
Temp, j

year.

Mean
Temp.

November

1850

61 |

1847

64 1

1844

63 1

11841

December

52 1

i «

January

63 1

February

«c

65 1

March

<«

63 1

651

April

80 |

75 |

24 The New-Orteam Medical and Surgical Journal,

Table 2d. Shoicing the highest and lowest points the Thermometer attained
during the months of the years specified.

iJlONlHS.

Year.

Lowest.

Highest.

Year.

Lowest.

Highest.

Year.

Lowest.

Highest.

Year.

Lowest.

Highest. |

November

1850

1847

1844

78"

1841

December

January

February

March

April

These observations were taken at 5 o'clock, A. M., Meridian, and 4,
P. M., and make a favorable showing, as compared with the table of
temperature given in the article alluded to.

In regard to the atmosphere, I shall quote the writer's own well timed
and appropriate remarks, as applicable to this place : " The general
effect of such an atmosphere is to increase the animal spirits — give a
mental elasticity, and strengthen the digestive organs ; and in a word,
one is constantly reminded of his stomach, while he forgets his
lungs."

Fogs hardly ever exist, though they prevail on the surface of the
river, to the great annoyance of navigation.

The winter air is tonic and bracing, invigorating all the organs, and
so equable as to give rise to but few inflammatory affections, and those
of the organs of respiration are comparatively rare, in comparison with
many other localities. They hardly ever prove fatal, are easily con-
trolled by treatment, and convalescence takes place rapidly. We ex-
pect that any given inflammatory affection, such as pleurisy, pneumonia,
and the like, can be cured in about one half the time that it takes to
accomplish the same result in colder climes ; consequently, we can
appropriately call our climate anti-inflammatory. In confirmation of
this opinion, we might remark, that enteric disease is not common with
the temperate, and that Cholera hardly visited this place at all, while
it was nearly all around us.

I shall notice but one topic more, and that is the prevalence and mor-
tality of consumption among us, as compared with Massachusetts^-
supposing this State will make a fair showing for the balance of the
Northern States.

The following facts and figures are taken from the ninth report of
the Births, Deaths and Marriages of Massachusetts for the year
1850 :

Dr. Magoun on Natchez as a Resort for Invalids. 25

" The whole number of deaths 16,606 ; 3,817 less than during the preceding
year; a difference of 18.69 per cent. Of this number 3,527 died of consump-
tion ; making the per cent of mortality from this cause 21.96."

Very near 22 per cent. While this is a fearful showing, yet it does
not indicate correctly the prevalence of the disease, as a considerable
per cent of cases are removed by travel for a change of climate. If
the increased per cent of mortality that would arise from this source
be added to that in the report, it would probably increase the per cent
to 30 — all originating there ; as it is well known that strangers do not
go there with consumption, and thus surely find an early grave.

The per cent of mortality for the past 28 years in this city, from this
disease, has been 13.8, and for the last 11 years, 11.328.* This per
cent embraces the whole number, strangers as well as those resident
and the native born. It is estimated that three fourths of the deaths
have occurred among strangers and the unaccli mated, who have come
here with the disease, seeking to improve their health, but were
past all recovery, in very many instances, before their arrival. This
estimate is founded upon the sexton's records, and the judgment of the
long resident and intelligent citizens of me place. According to this
showing, the indigenous cases, those originating among the fixed, sta-
ble, resident population, would not exceed three per cent of our mortal-
ity ; showing a difference between the two places of twenty-seven per
cent, or only one tenth as much consumption here as in Massachusetts.
Now, in conclusion, I will quote the concluding paragraph of the article
alluded to by Dr. Burnet :

" That although the advantages of a change of climate to those who have
some lung and strength to work upon, cannot be estimated too highly, yet
there are constantly occurring to the medical man cases, in which the expedi-
ency of the change requires the finest judgment to properly decide, for it em-
braces other than medical considerations. Although in advanced cases there
may, from such a change, be every reasonable prospect of the alleviation of
the severer symptoms that wait upon the fatal termination of the disease, yet
its advice must be considered as nearly always quite injudicious. Life may
sometimes be a little prolonged, but it is so at the expense of its sweetness.
The abandonment of home and friends, and the going away with the chance
of dying "among strangers, is even more than a serious matter; and I have
seen instances, when painful memories, not only to the friends, but to the me-
dical adviser, might well have been spared. And if there is ever a time, when
one needs all the comforts of home, and the consolations of near friends, surely
it is during the helplessness of the last days of consumption."

Natchez, Miss., April 1,1852.

* New Orleans Med. and Surg. Jour., Jan. 1852.

The New- Orleans Medical and Surgical Journal.

VI. — CLINICAL NOTES FROM PRIVATE PRACTICE.

BY E. L. SCRUGGS, M. D., OF LA.

It has been observed by some acute writer, that he who accomplishes
an acceptable essay, need not conclude, therefore, that he is capable of
writing a book worth reading ; and I would suggest, in continuation of
this idea, that it will be found easier, at least for a Physician in full
practice, who will observe carefully and take correct notes of the phe-
nomena, symptoms and result of treatment, in the more important cases
that are presented to him, to offer something valuable to the profes-
sion, in the way of notes of his cases, than by attempting, under such
circumstances, an elaborate essay upon disputed points, or the more
obscure subjects connected with the profession. Under this impres-
sion, and being convinced of the propriety of Physicians publishing
occasionally the result of their experience, I shall offer, from time to
time, as my professional engagements permit, notes of such cases as
appear to me likely to repa.y the trouble of perusal.

At present, I offer you notes of a few cases, taken somewhat at ran-
dom from my case book. Cases, that appear to have no necessary con-
nection with each other, but appear each to possess sufficient interest
to justify its publication.

Hereafter I may attempt to group together such cases as are alike
in symptoms, pathology, etc. ; or, such as being unlike in many impor-
tant particulars, yet admit of one general plan of treatment, or the use
of some particular article of the Materia Medica ; thus showing the
value of the agent used, and the varying circumstances under which it
may be brought into requisition with a prospect of benefit ; or again,
such cases, as being so much alike at the commencement of an attack,
in the general appearances and symptoms, as to make it an extremely
nice point to diagnosticate correctly between them, yet differing videly
in their causes, pathology and tendencies ; some cases having a natural
tendency to terminate in health with but little assistance from medicine,
while others, apparently of the same character, to the unwary and in-
experienced observer, tend certainly and rapidly to death, unless ar-
rested by the most prompt and energetic treatment. These latter sug-
gestions constitute, in the opinion of the writer, one of the most impor-
tant subjects for consideration at present connected with the medical
profession in the South. Allusion is here made to Typhus or Typhoid,
and Remittent or Miasmatic Fevers.

There is some difference of opinion amongst our medical men, as to

Dr. Scruggs* Notes from Private Practice.

the identity of the cause of these fevers ; a few maintaining that they
are merely varieties of the same disease, produced by the same morbific
agency, and consequently requiring the same general plan of treatment,
with only slight modifications in some particular cases ; while a major-
ity believe them to be produced by totally different causes, and conse-
quently requiring treatment diametrically opposite. The one bold, en-
ergetic and abortive in its character; the other mild, tentative and ex-
pectant. It is probably unnecessary for me to state, that I incline
strongly and decidedly to the latter opinion, as I have written more than
once upon the subject, and will probably recur to it again here-
after.

CASE FIRST.

August 19, 1849. — Visited Hannah, aet. 30, slave of N. S. Found
her suffering very considerable pain in the lumbar and pelvic regions ;
tongue heavily coated ; bowels constipated, not having had a passage
for four days ; pulse natural. Exam. pr. Vag. Touch : uterus prolap-
sed, cervix enlarged and pointing backwards, pressing firmly against
the rectum — that condition called by Dr. Bennett retroversion of the
cervix. The whole organ so firmly fixed as to prevent its being moved
in the upward direction with the force I thought prudent to exert upon
it. Passing the finger anteriorly, just behind the symphysis pubis, it
encountered a rather firm, immoveable body, conveying to the sense of
touch the size and general outline of the os uteri, with a membrane
stretched across it. I could not determine satisfactorily what this was,
but concluded, from the position of the os, that it was the fundus of the
uterus. I scarified extensively the loins and lower part of the abdo-
men, and with the cups abstracted as much blood as I could conveniently
in this way. A hip bath was then ordered, to be followed by hot fo-
mentations and a warm cataplasm ; the bath or fomentations to be re-
peated whenever the pain or tenderness in the region of the uterus
seemed to require it. Gave her pills of Calomel, Ex. Colocynth, C. and
Ipecac, with directions to move her bowels, if necessary, in eight hours,
with enemata.

18th. This morning I find my patient slightly relieved of the uterine
pain, but still suffering a good deal. T'ie bowels not having been
moved, the syringe was used repeatedly bringing away a quantity of
black, lumpy faeces, which afforded very decided relief at once. I then
examined the uterus again with the touch, and found the organ in the
same position, but rather more moveable. The tumor behind the sym-
phisis was extremely tender to the touch and slightly moveable, whereas

28 The New-Orleans Medical and Surgical Journal.

the uterine neck bore very considerable pressure in every directioa,
without giving pain. I then introduced the speculum, which only re-
vealed to the sight what had been equally well ascertained by the
touch, to wit : enlargement of the cervix ; no ulceration or abrasion
of the surface could be detected. She complains of irritability of the
bladder ; says the urine has been scanty, and thinks it has been mixed
with pus. I introduced the catheter without meeting with any obsta-
cle, although she made a little complaint upon its introduction, of sore-
ness of the parts ; an ounce or two of healthy looking urine passed, and
following the instrument, when it was withdrawn, were a few drops of
blood. I then put her upon the use of the Iod. Potass, to be followed
in ten days by a sol. Strychnia; and alternated with Tine. Ferri. Mur.,
in a bitter infusion ; to keep up for some time a slight mercurial action,
and move the bowels, when necessary, with any slight aperient ; to
continue the fomentations and poultices as long as any soreness or pain
existed about the parts ; to rub the spine twice a day with a stimulating
linament, and to apply a blister over the sacrum within three days, and
keep it running for ten or fifteen days. The catamenial discharge,
which made its appearance last night, and continues to pass off in suffi-
cient quantity to-day, is thick, dark colored, and offensive to the
smell.

19th. To-day Hannah is considerably improved ; her bowels have
been sufficiently evacuated ; the catamenia continues to flow, but in
smaller quantity ; same color and smell, however, and the womb in the
same position ; tried to replace it, but failed. Ordered her to maintain
the dorsal decubitus as much as possible, and continue the treatment as
directed yesterday.

Sept. 12th. Upon examining the uterus to-day, I find it in the same
position, but somewhat reduced in size. The uterine neck, is, however,
still quite large, and seems to be bent upon the body in such a manner
as to form, with it, a segment of a circle, with its convexity presenting
posteriorly. The tumor above is somewhat smaller than it was at the
previous examination, but still extremely tender to the touch. Whe-
ther it is the fundus bent forward ; a tumor in the anterior parieties of
the womb, or an inflamed ovarium thrown out of its normal position, I
am not able positively to determine ; but I incline to the opinion that
it is that malformation of the womb termed antiflexion ; and from the
impossibility of moving the organ in the upward direction, I am seri-
ously apprehensive that it is tied down by old adhesive bands of organ-
ized lymph.

Dr. Scruggs' Notes from Private Practice.

Oct. 2d. To-day, I find my patient going about attending to her
duties as house servant, without any pain or uneasiness in the pelvic
region. She informs me that her catamenia returned last at the regu-
lar period, occasioning but slight indisposition, and only for one day.
Upon examination, however, I find the organ in the same position, and
apparently immoveably fixed, and the tumor above still painful upon
pressure.

I may here remark, that I have treated, at different times, quite a
large number of cases of uterine disease, and generally am able to de-
cide, without much difficulty, upon the nature of the case ; but in this
instance I must acknowledge that I was not altogether satisfied to the
last

The history which she gives of her case is briefly this : That about
four years ago, while lifting a heavy piece of timber, she felt something
give way in the lower part of the abdomen, since which time she has
constantly suffered with prolapsus uteri. That her catamenia had been
very irregular, and that at each catamenial effort she had suffered in-
tensely. She has been treated by a number of Physicians, some of
whom made slight vaginal examinations with the finger, and pronounced
it simple prolapsus.

Whether I am right in my diagnosis or not, I think I may urge with
propriety the necessity of a thorough examination in all cases, where,
after an accident, much pain is felt in the uterine region, with the view
of replacing the organ, should it be found displaced ; and this should
be done at as early a period after the accident as possible, as well to
prevent these adhesive bands tying the organ down in its abnormal
position, as to correct the constitutional irritation and disturbance —
lesions of structure, etc., which must always result, sooner or later,
from these displacements.

CASE II.

Mary, black negro, aged 19, slave of Mr. Robert Gallaway, residing
fifteen miles east of Memphis, was taken, April 29th, 1849, with vio-
lent pain in the stomach — thought by the family to be "cramp colic."
The pain and uneasiness continuing to increase, after the bowels had
been well evacuated with " Cook's Pills," they determined to call in
a physician. When I arrived, at 8 oclock, A. M., on the 30th, her
extremities were cold ; pulse 80 beats to the minute and extremely
feeble ; tongue natural ; respiration 60 to the minute ; pain and great
oppression in the epigastrium and hypochondriac regions, Stomach

30 The New-Orleans Medical and Surgical Journal.

distended with gas ; no thirst ; lungs : respiratory movement slightly
altered, but no rhonchi ; slight pain in the head.

Treatment — Extensive scarifications and cups over the stomachy
liver and spleen, followed by hot fomentations ; sinapisms to the extre-
mities, and hot corn about the feet and legs. Internally : 20 gtts. Sol.
Camphor in Chloroform, which caused an immediate discharge of gas
from the stomach, affording slight temporary relief. Directed Calomel
grs. iij., Morph., gr. Ipecac, gr. |, to be repeated every three hours
for three times, omitting the Morphia if the pain of the head should
return, which had been relieved along with the distress about the sto-
mach, &c.

When I returned, about 5 o'clock, P. M., I found her breathing more
oppressed, and a most distressing cough had set up within the last two
hours. There was dulness on percussion over nearly the whole of the
right lung, with bronchial respiration over the right, and purile respira-
tion in the left lung. Pulse still at 80, and feeble; same weight still
complained of about the epigastrium. Wet cups to the right lung,
followed by hot fomentations, and afterwards by hot cataplasms to the
lungs, stomach and bowels. A solution of Ta rt. Emetic was then given
in elm water, with directions to increase or diminish the quantity, ac-
cording to the effects upon the stomach ; the object being to produce
slight nausea, but no vomiting. Thft second portion, given her after I
left, produced free emesis of bilious matter, and it was then discon-
tinued. The fomentations were continued for several hours, which had
the effect of relieving the pain and oppression entirely by 10 o'clock at
night, when a dose of Calomel, Morphia and Ipecac was administered,
and she slept quietly and comfortably during the remainder of the
night.

31st. Twelve o'clock to-day found her breathing and pulse perfectly
natural ; no pain complained of any where ; slight tenderness upon
pressure over the stomach and liver, over which I applied a blister ; the
bowels not having been moved, I gave her four pills of Comp. Ext.
Colocynth, Calomel and Ipecac, with directions to use the syringe in
eight hours, if necessary. There was free discharge from the bowels
within the time.

Sept. 1st. Perfectly free from pain, and all evidences of disease have
vanished.

Prescription: Five grain doses of Quinine, three or four times a day,
for two or three days ; light diet, and the bowels to be kept soluble
with oil and turpentine.

Dr. Scruggs' Notes from Private Practice.

This would appear to have been a case of congestion of the portal
viscera, extending, by contiguity of structure, to the right lung. Con-
gestive fevers of every variety, affecting each of the great splanchnic
cavities, have been rife in that country since its earliest settlement ;
becoming less frequent, however, each year, as the country is settled
and cleared up.

CASE III.

Visited on the 12th August, 1849, Mary, daughter of H. O., Esq.,
set. 6 years, 18 miles East of Memphis. When I entered the house she
seemed to be in the greatest agony ; her face fiushed, pulse 120 beats
to the minute, but not very full or strong. Her mother, observing my
somewhat surprised and attentive look, remarked, "it will pass off in
a few minutes." i then learned that she had had several of these par-
oxysms during the day; that at each time her pulse would become ac-
celerated, her face flushed, and skin dry and hot ; gradually it would
pass off, when the perspiration would pass off freely, her face become
pale, and the pulse reduced. Examination of the abdomen revealed
very considerable enlargement of the spleen, distension, by gas, of the
stomach, and tenderness in the region of the liver ; to which latter part
nearly all the pain was referred. Mrs. O. remarked that she had never
witnessed such symptoms in a child ; that they resembled, more than
any thing she had ever seen, " the grinding pains of labor." Wet cups
were applied over the liver, stomach and spleen, and, immediately
after, hot fomentations ; with directions to continue the fomentations
for several hours, and then apply a pepper poultice ; which latter was
to give place to the fomentations again, should the pain return. I then
gave her Hydr. S. Mur. and Morph., to be repeated every three hours
for four times, the bowels to be moved afterwards with 01. Ricini and
Vermifuge. I requested the lady to carefully inspect the passages from
the bowels, and report to me at my next visit. I suspected the passage
of gall stones or inspissated bile, with spasms of the gall ducts.

13th. No return of pain since my last visit ; slept well during the
night; bowels well evacuated this morning ; evacuations dark, mixed
with lumpy matters, the character of which I could not determine, as I
did not see them. Passed three large round worms ; is in good spir-
its, and free from fever. Directed Quinine, grs. ij., Ipecac gr. ss., every
hour for four times ; fomentations over the bowels twice a day for two
or three days, after which, blister over the spleen and liver, with fric-
tion along the spine; to dress the blistered surface over the spleen with
iodine ointment, and give grs, iij. Hydr. c. Creta twice a day, and move

Ttie iYe#> Orleans Medical and Surgical Journal.

the bowels, when necessary, with small doses of Cream Tartar, Mag.
nesia and Sulphur. After all abdominal tenderness disappears, to give
Mur. Tinct. Ferri in a bitter infusion.

21th. Her father called at my office to-day, and informed me that
the little girl had had no return of fever or pain, but that she had be-
come somewhat jaundiced, her appetite failing, and some puffiness
about the face. I gave her a Sol. led. Potass 20 grains to the oun^e,
and directed it to be commenced in 10 drop doses three times a day,
and gradually increased to 30 drops, or until its effects were manifested
upon the system. Then to use the iron again, and continue the dress-
ing of Ungt. lod. to the spleen. Learned a short time afterwards that
her health was entirely restored.

Although not strictly relevant, we will conclude this article by an
attempt to clear away the thick atmosphere of koino-miasmata which
seems completely to envelop, and seriously to affect, the mental consti-
tution of Dr. J. C Harris,* of Alabama. We regard it, however,
as a rather difficult task, since his accomplished and scientific friend,
Dr. C. J. Clarke, of the same State, seems to have failed in his efforts
to clear away the malarial fog which seems destined ever to obstruct
his mental vision. It would appear that he rejoices in being one of
that select few, who claim to have made the important discovery, that
malaria is the cause of all diseases, and ergo, Quinine as the grand
and all-powerful antidote. Now, if this theory had for its support only
the little word truth, it would justly claim for its promulgators the ad-
miration of the world, and would doubtless revolutionize the whole
world of science; changing the occupations, even, of those intellectual
and bright spirits of our noble profession, who so unceasingly labor to
disclose the hidden mysteries in Pathology, Physiology, etc., forcing
them, perchance, from their "labors of love" to the more vulgar, yet,
probably more healthful occupation, of wood choppers in the native for-
ests of the beautiful Cinchona tree.

Alas, for Dowler. Gross, Gerhard, Marshall Hall, and a host of other
luminaries of our profession ; thus might they feelingly exclaim —

" Farewell ! Othello's occupation's gone !'"

Science and skill in medicine would become a vulgar jest and by- word,
and " the Doctors" laid aside as a " useless piece of furniture." I
must acknowledge that I never could, for the life of me, bring myself to
believe that the base metals could, under any circumstances, ever be

*Nmv Orleans Medical and Surgical Journal for May, 1851.

Dr. Scruggs' Notes from Private Practice.

converted into gold, or that the intellect or ingenuity of man would ever
enable him to discover a universal Catholicon.

But seriously, let gentlemen reflect for a moment upon the
practical effects of this ultraism in medicine. A few years ago, in the
great Mississippi Valley, every thing was expected to be accomplished
by the use of Calomel. Prof. Drake tells us that some Doctors in
Louisiana boasted of having given Mercury enough to one patient to
freight a steamboat. I myself have known a man to die with over two
thousand grains of Calomel in him, which had been prescribed by a
regular Physician. Perhaps our malarial friends of the present day
would tell us that had Quinine been used in place of the Calomel, all
would have been right.

That forty, sixty, or one hundred grains of Quinine may sometimes
be administered without destroying life, T will not take upon me to deny;
but that such horse doses are either safe or useful, I do very much
doubt, maugre the very respectable authority in support of the practice.
But even could we believe, for a moment, that it would do no mischief,
— a belief that we are very far from entertaining at present, — yet the
very strong objection would still obtain against it, to wit : that it is a
very unnecessary and wasteful expenditure of a very costly and most
valuable medicine.

Now, it must be clear to every reflecting man, that this ultraism in
medicine, and consequent over-estimation of the remedial virtues of
particular articles of the Materia Medica — this proneness to '* hobby
riding" — this beautiful simplicity in prescribing, by Physicians, has
done more to prejudice the community against us, to bring our profes-
sion into disrepute, to foster quackery in all its disgusting forms of
"King Cure All's,' Homoeopathy. Hydropathy, Thompsonianism, etc., —
than all the real and open enemies of true science could ever have ac-
complished. Ask the Planter why he trusts the lives of his valuable
s)aves to the medical skill of his overseer, and his answer is, " that the
Doctors say that Quinine can cure all diseases, and my overseer can
give that as well as a Doctor."

The ravages committed upon the constitutions of a confiding public
a few years ago by the outrageous abuse of Mercury, has caused such
a prejudice in the common mind against the use of that article, as se-
riously to embarrass the practice of medicine ; making it necessary,
frequently, to administer it stealthily, without the knowledge of even
the patient's friends. The same prejudice is beginning to be very

The New Orleans Medical and Surgical Journal.

strongly manifested against, probably, the next most valuable agent we
have, to wit, Quinine, and for the same reason, that Physicians are in
the habit of giving it so liberally and indiscriminately, as frequently to
cause serious consequences, if not death ; such as deafness, blindness,
neuralgic pains, etc.

Dr. Harris "cannot, for the life of him, understand how Typhoid
Fever can exist without typhoid symptoms." To this we will simply
reply, learn the difference between an adjective and a noun ; and learn
that a word may be used simply as a name (arbitrarily, if you please)
or to express a condition. He must be either a very careless reader,
a very unfair critic, or else from menial idiosyncracy, incapable of com-
prehending the simplest proposition in the English language ; and un-
less he turns from the error of his ways, studies his profession with the
view of obtaining correct information, instead of finding fault with the
labors of his professional brethren, humble though they be, he will in-
evitably place himself permanently in the unenviable attitude of the
foolish bird alluded to by his friend, Br. Clarke. Certainly it will be
conceded by him, unless he is determined to doubt the correctness of the
observations of every writer upon the subject, that there are varieties
of this disease, and that some cases run a miVl course, without, at any
time during the attack, presenting typhus or typhoid symptoms, properly
so called. These cases are, indeed, frequently the most tedious that
we have to treat. Had this variety not existed, there never could have
been any dispute about the propriety of the name. But as " there are
none so blind as these who will not see," and as we are inclined to
give the Doctor credit for a good deal more of intellect \han fairness,
we despair of convincing him; or at least we do not expect him to
acknowledge his error. With the " lights" before him now, however,
we hardly think he will have the hardihood to deny the existence of
Typhoid Fever in the " Sunny South."

We strongly suspect Dr. Harris to be in the dilemma of some that
we wot of, who, failing to recognize the difference between two diseases,
which, having some symptoms in common at the outset, yet differ widely
in their nature, and in the indications of treatment, are so much cha-
grined at the mistake they have made, that they refuse to acknowledge
it, although fully convinced of their error ; reminding us of the horse-
jockey, who, having inadvertently stated that his horse was seventeen
feet high, deemed it important to his honor to maintain the correctness
of it afterwards. I trust, however, that he is not like them in some

JJr. Massif on Yellow Fever,

other respects ; willing to profit in their practice by the lesson taught
them, yet not only denying the source from which they obtain their in-
formation, but even casting reproach upon its authors ; reminding us
strongly of those plagiarists who not only steal from others, " but, like
the harpies, befoul and bespatter those whom they have plundered."

VII.— OBSERVATIONS ON YELLOW FEVER.

BY J. C. MASSIE, M. D., HOUSTON, TEXAS.

A. Hester, M. D.

Dear Sir — Your past favor, requesting me to " write for the Journal
whatever I might see fit," has remained a long time unanswered, and
as the season is approaching when we may expect Yellow Fever, and
as I have been frequently interrogated " as to the causes of this fever,
and whether the same is contagious, and my views of treatment," I have
concluded to trespass on your pages.

Epidemic diseases are chiefly of the acute or febrile class ; they are
apt to prevail in the spring, but frequently in the summer and autumn ;
happily for us, and makind in general, that our ignorance of the causes
of many epidemic diseases does not destroy our interest in the study of
their pathology. If medical gentlemen would be contented to look
calmly into the many series of events belonging to epidemics, and set
aside their hypothesis and conjectures, we would not be so much at a
loss to account for the causes as at the present day. The records of
pestilential epidemics present us with various opinions and statements,
and frequently as much at variance as it is possible for any two differ-
ent theories to be ; truth, however, is sacred, and error cannot be dis-
seminated without producing harm ; how important, then, is the duty of
medical observers to investigate fairly and impartially, and to report
with truth and fidelity.

We have examined this subject to some extent, (as to the causes pro-
ducing it in this city) but as we do not intend an elaborate article, we
will content ourselves by merely alluding to the most prominent facts.
As far, therefore, as we are enabled to form any general conclusions
in regard to the circumstances which conspire, in many cases, to pro-
duce a pestilence, the following are substantially our deductions :

1st. Intemperature of the air, or peculiarly irregular weather.

2d. Local impurities, the result of putrefying substances, more espe-

36 The New-Orleans Medical and Surgical Journal.

cialiy of animal matter, if located in marshy situations, produce
miasma, which aggravates the preceding causes by polluting the atmos-
phere.

3d. And (I think very important) human secretions and excretions ;
the latter become virulent by accumulation, and almost poisonous dur-
ing a fever, "which always," says a distinguished author, "is the cause
of the fever acquiring a degree of malignity which is proportioned to
the congregated mass."

We do not wish a latitudinous construction of this sentence, so as
to infer that we are willing to concede to authorities of considerable re-
spectability, that the solution of the question is to be found in all cases
in the filth of the town or the state of the sewers ; though we are free
to admit they are great auxiliaries.

4th. Green timber, or any other vegetable matter, emits a very offen-
sive miasma, if suffered to remain in stagnant water.

We find that a great many authors lay great stress on the signs
which are the antecedent indications of an epidemic, "such as intem-
perate seasons and unusual weather, (which we think quite likely)
great mortality among any species of the lower animals, and great
scarcity among birds," the singular changes which have been observed
to occur in the common varying diseases of the place before, during
and after an epidemic, the facts connected with epidemic pestilence, and
on the other hand, the exemption of those places where due attention has
been given to cleanliness and a rational system of health police. Mor-
tality among animals very frequently follows intemperature of the sea-
sons. In the pestilence that raged at New Orleans in 1819, " we are
told that cattle died, horses, oxen and cows, with rotten tongues ;
sheep and hogs with their hoofs dropping off, and calves, with rotten
ears."

To found, however, any truth on science, we must have strict re-
course to our general and impartial observations ; a solitary isolated
fact is only valuable so far as it may tend to establish general laws.
There is no question, however, in regard to one fact, that at the com-
mencement of an epidemic the proportional mortality is always greatest.
We have always another very remarkable fact in all the cities and
towns in Spain which suffered with Yellow Fever ; they were, with
the exception of Cadiz, extremely filthy, even disgustingly so ; and a
fact worthy of notice, that Cadiz escaped very lightly, in consequence
of a rigid syste?n of police which had been adopted, and the result was,
as history testifies, that they seldom have suffered since. And 1 would
here most respectfully suggest for your consideration, that if a prudent

fin Mass ee on Yellow Fever.

and systematic adoption of police should prove of benefit at the very time
of an epidemic, to lessen the mortality and to mitigate the disease, as it
has often been found to do, how much more should such measures prove
beneficial, if practically adopted in any city, as the constant and most,
ejjicient means of preservation.

In regard to contagion, I hold that it is not a necessary incident to
any disease of this class. Medical men themselves, as well as the pub-
lic, are worn out with statements from different authors, and " indeed
they may well wonder at the imperfect state of science which has not
settled points of so much importance." During the last fifty years, me-
dicine has assumed more of the character of an exact science than it
held before ; and of the history of contagion, little is known for the
space of a century after its origin. In 1545, we are informed by an-
cient authorities, that Pope Paul III. convoked reluctantly the Council
of Trent ; and being anxious to remove the Council to Bologna, he was
very slow in contriving means for the accomplishment of his purpose.
An epidemic was prevailing in Trent at the time of the assembling of
the Council, and availing himself of this circumstance, the Pope caused
it to be proclaimed that the disease was contagious, and therefore dan-
gerous to the health and lives of the fathers. In this proclamation he
found no difficulty in inducing Physicians and others to concur. A
committee of enquiry, composed of prelates, was formed by Cardinal
Morito, (I quote from memory) who was an artful man, and easily con-
trolled by his Holiness ; and before this venerable body, Frucastorius,
and many other Physicians, (who, from bribery, says history) being
solemnly examined, testified to the Pope's opinion. " The consequence
of this manoceuvre was threefold ; the Council was removed, his Holi-
ness gained his end, and the belief in contagion established by authority
of the Church."

And it is but too true, from facts, that that scheme of protection has
descended, with but slight modifications, to the present time. It has
been sustained by authority ofthe Romish Church ; and in modern days
it has been sustained principally from this precedent; for we are bold
to say, that nine-tenths of the Physicians of the present day will accord
with us in saying, that truth and science, from investigation, have af-
forded it no support. To exhibit some of the many ridiculous causes
assigned, and the testimony submitted on the part of those who were
anxious to establish the principle of contagion, it may not be amiss to
recite a few of the facts from the most enlightened witnesses. They
were as follows :

38 7 Vie New -Orleans Medical and Surgical Journal.

" A fur or leather cap, worn 35 years previously, by a person witli pesti-
lence, communicated the disease to 25 Germans in Verona, and destroyed them
all."

" A feather bed, in which a pestilential subject had lain, on being shaken
up some years afterwards, in Waterslau, produced a fever, of which 9,500 per-
sons died."

" A rag-, which had been infected fourteen years before, on being thrown out
of a window, sent its plague poison abroad, and produced frightful mor-
tality."

On the authority of these absurd tales, says a distinguished author
and many others which I could recite, equally as incredulous — (" as, for
instance, this : in modern days quarantines are established for forty
days." Why forty days ? Is it from the fact that it is the usual time
allotted to dog days ? but I presume it is from the fact that it corres-
ponds with the forty days lent). Upon all of this has a judgment been
passed, and a code of laws been established, which the accumulated
experience and wisdom of centuries have not yet set aside. It seems
to us in the nineteenth century that it is time for science to obliterate,
even from the pages of the past, a demon that has even shackled com-
merce. And yet, there are not wanting individuals of distinction, who
still endeavor to maintain their truth, and perpetuate their influence.
And I will here remark, so far as my knowledge extends, that every
candid and well conducted enquiry into the hypothesis of contagion,
has resulted unfavorably to it. Dr. Rush was candid and honest enough
to recede from his first positions ; and it is admitted by high medical
authorities, that among the former advocates of contagion in the West
Indies, scarcely one can be found in the present day.

Dr. Bono, who resided in the West Indies for a number of years,
and whose opinions on Yellow Fever are entitled to great confidence,
says, " I have proved in the naval hospital that the Yellow Fever
cannot, by any possibility, be communicated from one person to ano-
ther."

In 1823, in this country, while 567 Physicians were against the doc-
trine of contagion, 28 only were in favor of it ; " and in this generation
an equal unanimity prevails in the profession as to the non-contagious
nature of the disease ; and he who advances the opposite doctrine se-
riously, is deemed no more worthy of notice, much less a refutation*
than would be an advocate at this time of the Ptolemaic System."*

" We do not allow the fever commonly called the Yellow Fever, to
be infectious." This opinion is supported by many American authors;

* Amer. Jour. Med. Sciences, 1829, p. 573.

Dr. Massie on Yellow Fever.

but at the same time we must admit that a vessel may be the seat of
infection, and convey the disease from place to place ; and we see
that it is lately contended, that if the place to which it is conveyed be
extremely filthy, the probability is, that it may find an affinity in the
atmosphere, and it may act as a spark to ignite the whole material ;
but we should most rigidly observe, generally, that the great error in
attributing to contagion, that which should honestly be attributed to
accumulated causes of filth and decomposition of vegetable and animal
matter, as stagnant water, etc.

As regards the treatment of Yellow Fever, I would simply remark,
that with the mass of practitioners, it is as much at variance as the
cause. The rationale of Mr. Wilson I deem worthy of attention. He
admits, as I presume all will, " that in many cases the resources of our
art have little influence in its worst forms." "He even goes so far as to
say, that this fever is utterly beyond control ; and indeed it is not per-
mitted us to be too sanguine as to the efficacy of any remedy in even a
seemingly mild case of the disease."

It has always been a matter of astonishment to me, in epidemics,
that no treatment, during their prevalence, ever commanded the general
assent. Some place their reliance on active and vigorous depletion ;
others extol Calomel to ptyalism. The latter in the United States and
England, has more advocates, probably, than any other. "Although
M. Louis and other distinguished gentlemen contend that the liver is
the only organ constantly, and more or less uniformly altered." The
same opinion is entertained by a very distinguished and truly scientific
gentleman of Galveston, Dr. A. Smith, (if my memory serves me right)
yet the former contends " that experience has sufficiently proved that
no dependence is to be placed in mercurial preparations of any
sort."

As to the former treatment of depletion, venesection, &c, we hold
it of extreme doubtful utility, if not absolutely improper. I have had
some experience in the treatment of Yellow Fever, during my residence
upon the Mississippi, and have treated some cases in this city. Upon
the first symptoms of the disease, I recommend a warm mustard pedi-
luvium to the extremities, sinapisms to be applied immediately after,
a large one between the shoulders, to arrest the hot stage, and produce
a free determination to the surface. We use a small portion of the pure
Tincture of Aconite, repeated at short intervals until the desired ob-
ject is effected. (From this you may draw the inference that we are
a Homoeopathist — not so ; I am an Eclectist, in its broadest sense, be-
lieving there is some good in each of the different systems, and it is my

40 The New-Orleans Medical and Surgical Journal.

duty as well as privilege to investigate and cull therefrom. After
which, four ounces Rochelle Salts, with or without 2 grs. Tart. Ant.,
given in small doses during the twenty-four hours. But if there is an
obstruction in the gall ducts, as manifest from the absence of the biliary
secretions, I do not then hesitate to combine a few grains of Sub.
Hydrg. or podopkylline, with a grain of Opium, and continue until
biliary secretions re-appear. Enemata we generally have recourse to
as useful auxiliaries. Frequently we have seen the disease localize it-
self upon the bowels, and commence a termination by active hyperca-
iharsis; in this stage astringent injections of Opium, Catechu and
Starch will most frequently avert it. Quinine we commence with at
the outset, with 10 grain doses, (we view this dose as a sedative) with
a small portion of Sulphuric Acid, as the circumstances of the case dic-
tate. Frequently, however, any treatment has to be varied, from the
fact, in the majority of cases, that great irritability of the stomach is
always present ; and if cupping, epispastics, or sinapisms fail to allay
irritability, we have frequently seen the following prescription do so :

Ifc Lemon Juice, % i

Sub. Carb. Ammonia, 9 ii M.

And when the effervescence has ceased, add common Syrup 2 ounces,
Camph. Mixture 1 ounce, and give from one to two table spoonfuls every
three or four hours ; frequently a drop or two of Kreosote in milk will
allay the irritability ; and as a dernier resort, and I have seldom seen
it fail, a blister along the spine is a valuable auxiliary. In regard to
treatment, we are general, as we would occupy too much space to be
special.

We would remark that we have modified our treatment in some
cases, substituting Oil for Mercury or Podophylline ; but we are not
prepared to say that it is ever attended with any better success.

The sequelae, prognosis and morbid appearances are important, but
we have already, we fear, trespassed too much upon you .

Dr. Ely on the Motive Power of the Blood.

Vflf. — THE MOTIVE POWER OF THE BLOOD.

BY ALBERT WELLES ELY, A. 31., Mr. D., OF NEW ORLEANS.

Some years ago Mrs. Willard, a distinguished teacher of Troy, New
York, promulgated a new theory regarding the circulation of the blood
in the human species. She had matured her theory as early as 1839 ;
but owing to the many discouraging opinions of nearly every one to
whom she presented it, she did not publish it until 1846. The book
was read, laid aside and forgotten, not one solitary person of any note
venturing to subscribe to the theory announced. The work was, how-
ever, by no means treated with contempt. Coming from the pen of a
distinguished lady, this alone was sufficient to insure it a perusal, [t
was carefully examined by the learned, both of Europe and America ;
but it was universally condemned, as a theory the result of a too hasty
deduction ; as opposed to many well established truths in physics ; and
as one not accounting satisfactorily for well known phenomena.

The theory, as announced by Mrs. Willard, in her own words, is,
" that respiration, operating by animal heat, produces an expansive
power at the lungs, and thus becomes the principal efficient cause of the
blood's circulation" She maintains that the oxygen of the air inhaled
heats the blood in the lungs, and causes it to expand with a force suffi-
ciently great to produce the circulation, as seen id the human body;
that the heart, from its position in the body, was not designed to be the
principal force* to carry on the circulation ; and that the only use of
the heart is to open the valves and convey the blood to the lungs. t
She makes the heart a mere vabe-opener and feeder of the lungs.

This strange theory, as we have said, was read, laid aside and for-
gotten. Physiologists have not even deemed it worthy of a notice in
their works. Mrs. Willard has attempted, in her work, to refute some
of the objections urged against her theory, but we think she has not
succeeded. We are disposed to give her all praise for her ability, but
at the same time truth and science require us to say, that her denuncia-
tion of the theory commonly received by physiologists is hardly justi-
fied by her facts and her logic.

The almost perfect oblivion into which Mrs. Willard's theory had
fallen was suddenly revived by a letter from our distinguished citizen,
Dr. Samuel A. Cartwright, dated December 1, 1851, addressed to Mrs.

* Motive Powers of the Blood, p. 45.
f Ibid., p. 42.

The New-Orleans Medical and Surgical Journal.

Willard, and published, along with her reply, in the Boston Medical
and Surgical Journal, on the 7th January, 1852. In this letter Dr.
Cartwright announces the resuscitation of Mrs. Willard's theory of the
motive powers of the blood, by a phenomenon, which, he declares, has
established it " beyond all doubt or dispute." This phenomenon was
witnessed by Dr. Cartwright, at the vivisection of an alligator, by Dr.
B. Dowler, on the 20th August, 1851. The animal had been killed,
as was supposed, by tying the trachea. In about 30 or 40 minutes
after the ligature was applied, the animal was laid on the dissecting
table, apparently quite dead. After exposing to view the thoracic and
abdominal viscera by Dr. Dowler, the lungs of the animal were inflated
by Prof. C. G. Forshey. In about seven minutes the animal was, in
the language of the latter gentleman, " wide awake and ready to de-
fend himself." His actions were so vigorous, that it became necessary
to hold him, and tie him to the plank, in order to continue the vivisec-
tion. Such are the facts, as given by Dr. Dowler, Dr. C. R. Nutt,and
Prof. Forshey, who were present at the vivisection.

Now, the great phenomenon perceived in that vivisection, by Dr.
Cartwright, and which, as he declares, has established the theory of
Mrs. Willard " beyond all doubt or dispute," and " clearly proved that
the primum mobile of the circulation and the chief motive powers of the
blood are in t\i<?. lungs, and not in the heart," is the simple fact, that
the animal was resuscitated (after strangulation by tying the trachea)
by inflating the lungs. This is the sole fact upon which Dr. Cart-
wright bases his adhesion to Mrs. Willard's theory, and which he my-
thologically declares to be her " apotheosis."

The subject has excited an animated discussion in the pages of the
Boston Medical and Surgical Journal, and we propose in the present
paper to examine some of the arguments by which Dr. Cartwright en-
deavors to maintain his adhesion to the new theory.* The high stand-
ing of Dr. Cartwright as a citizen, a physician, and a man of learning
and ability, entitles his observations and arguments to respect and ex-
amination. He will therefore, we trust, look upon this review of his
opinions as prompted solely by a regard for truth and a love of science.
Truth is all we care for, let it come from what source it may ; and we
trust, furthermore, that we are not too tenacious of our opinions to be
ready to surrender them for others the moment we discover our
error.

* Dr. Cartwright and Dr. E. E. Marcy, of Hartford, Conn., are the only
ones who declare themselves converts to Mrs. Willard's theory, in the United
•States, if not in the whole world.

Dr. Ely on the Motive Power of the Blood.

" The chief motive power of the blood is in the lungs, and not in
the heart," says Dr. C. This he thinks is demonstrated by the above
experiment with the alligator ; but how, is the question. Admitting the
resuscitation by means of inflation, does this resuscitation prove that
the chief motive power of the blood is in the lungs? By no means.
When resuscitation takes place after inflation, what must have been
the first internal movement that preceded the first signs of life ? Evi-
dently, the circulation of the blood through the arteries and veins. But
what proof have we that the blood began to circulate first, before the
heart began to act ? According to Mrs. Willard's theory, in a case of
resuscitation, the first movement is that of arterial blood in the lungs
towards the heart, caused by heat alone, generated by the oxygen of
the air ; and the second movement that of the heart. But this is, at
best, a bare assumption. It cannot be shown, that in a case of as-
phyxia, by strangulation, or tying the trachea, the first movement of the
circulation takes place in the lungs, on applying artificial respiration.
The artificial respiration fits the blood for circulation, and nothing more;
and if, at the same time, the heart can be made to act, the circulation
is established, and the resuscitation follows. Hence it is that in restor-
ing these asphyxiated, by any means whatever, mere inflation of the
lungs is always insufficient. The blood cannot be made to circulate
by that means alone. Means of raising the temperature of the body,
and of stimulating the nerves and nervous centres are required, so as to
get the heart into action, and then the circulation and animation fol-
low. Cases of resuscitation from drowning have occurred, in which
inflation of the lungs was not resorted to at all. Friction and external
appliances to communicate heat to the system, were all that were re-
quired ; and it is highly probable that all cases of asphyxia require
these.

In the case of the alligator, vivisected on the 20th of August, 1851,
which made Dr. Cartwright a convert to the new theory, and caused
him " to become one of the standard-bearers of the Filia nata Jovis*
of the New World," we doubt whether the alligator was really asphyx-
iated ; for the ligature was not about his trachea more than an hour.
Dr. Dowler says about 30 or 40 minutes ; Prof. Forshey 20 minutes ;
and Dr. Cartwright about an hour. Now, how is it possible that the
alligator in question could have been asphyxiated, or stone dead, or dead
at all, after having a ligature about his trachea for only one hour, at

* Mrs. Willard has assuredly too much good sense not to disclaim this in-
flated compliment ot Dr. C.

44 The New-Orleans Medical and Surgical Journal.

most ; when it is well known that alligators can remain under water
almost any length of time ? They are known to lie at the bottom of
lakes and pools of water whole days, without coming out to take the
air. How, then, can an alligator be killed by tying a ligature about
his trachea? Undoubtedly they become stupid on the application of
the ligature, and that they remain so for a time. When they go to the
bottom of lakes, they lie there perfectly still and stupid, apparently,
until, after a long time, they arouse themselves and come out.

But we have proof positive on this point. We know, positively, that
a ligature about an alligator's trachea for one hour only, will not kill
him. I will cite a case : On the Oth of May last, the trachea of an
alligator was tied by Dr. Dowler, in the presence of others of this city,
for the express purpose of repeating Dr. Cartwright's experiment of
inflating the lungs, made on the 20th of May, 1851. The animal
became stupid, like the other, at first; but just as they were preparing
to inflate, the animal, who had appeared dead, suddenly revived of his
own accord, and fought the by-standers most desperately, in spite &f the
wicked ligature about his trachea ! !

What, then, becomes of Dr. Cartwright's statement, that " it is a
remarkable fact that tying the trachea is the only means by which that
animal can be expeditiously killed ?" And what, too, becomes 6f the
proof, afforded by the experiment of the 20th of August, 1851, of Mrs.
Willard's theory? Is it not highly probable, that that alligator was no
more suffocated to death than its brother martyr to the cause of science
of the Oth of May, 1852? Undoubtedly it would have revived, with
the ligature about its trachea, if let alone, if Dr. Cartwright had suf-
fered the alligator to remain undisturbed a little longer, he would have
been spared the pleasure of recording the apotheosis of Mrs. Willard,
and of congratulating her on the probable happy result of her new the-
ory— the discovery of " the art, so long sought by the ancients, of mak-
ing the old younger, children healthy, men vigorous, and women
pretty."*

Dr. Cartwright will please excuse me for my seeming incredulity,
for I am never over-disposed to take too much for granted. His Boston
opponents, who probably never saw an alligator in their lives, are ex-
cusable for not questioning the data of the case.

Dr. Cartwright states, that the heart of the alligator (vivisected on
the 20th of August, 1851, by Dr. Dowler, and upon which alone he
bases the " demonstration" of Mrs. Willard's theory) was dead and

* See Dr. Cartwright's letter in the Boston Med. Jour, of Jan. 14, 1852.

Dr. Ely on the Motive Power of the Blood. 45

cold — that he took it in his hand — that not a motion or sign of life oc-
curred. We do not question that he took the heart in his hand, and
that it felt cold. He probably knows that the heart of an alligator al-
ways feels cold ; but as to the heart having ceased to contract, in an
alligator like that, just killed, we think there must be some mistake. The
heart of the alligator is the last thing to die. It will contract itself for
hours after being entirely removed from the body. Neither Dr. Dow-
ler nor Dr. Nutt, who were present, observed that the heart was dead,
although Dr. Dowler performed the dissection. These facts, together
with another, that Dr. Cartwright did not write his account of the ex-
periments to Mrs. Willard until some months had elapsed, leave room
for supposing that there is some mistake about the heart being dead.
We think it could not be so. The heart of an alligator, five or six feet
long, is small, and contracts slowly and at considerable intervals. If
the heart still contracted, in spite of the ligature about the trachea, the
circulation must have been going on, and therefore the inflation of the
lungs did not start the circulation.

The circulation of the alligator is independent of respiration, as is
proved b}r its being able to remain under water for whole days, and by
the experiment of the 6th of May last, in which the alligator, with his
trachea tied, revived of himself, after lying stupid about half an hour.
The structure, too, of the circulatory system, in the alligator, is pre-
cisely such as would lead one to suppose that he could live without
breathing, and even with a ligature about his trachea. About one
half of the blood in the alligator circulates constantly through his sys-
tem, without ever going to the lungs at all. His structure is such, that
it appears to be optional with him whether his blood be cErated or not.
Like all other animals, he can live as long as his blood circulates, and
this must take place, whether he is at the bottom of lakes or basking in
the sun on their shores.

It is certain, indeed, that the respiration of the alligator is very slight.
It requires the closest observation to discover that it breathes ; for
there are none of those external movements of the throat and chest
so marked as in other animals. It probably draws its breath very
slowly, and at long intervals. The blood of the alligator is destitute of
that bright red color of the blood of other animals. The mechanism
of these animals, indeed, indicates that they were not to be much trou-
bled with respiration ; for they have no diaphragm, and force air into
the lungs by a process resembling deglutition or swallowing ; so that.

46 The New-Orleans Medical and Surgical Journal.

strange as it may appear, says Dr. Carpenter, a reptile may be suffo-
cated by propping its mouth open, thus giving it too much air.

It is, we think, well established, that the alligator can live a long
time without air, and that its respiration is very trifling, compared with
that of other animals. I ascribe the great and sudden excitement, and
powerful muscular strength which the animal exhibits when its lungs
are artificially inflated, as in the experiment before mentioned, to the
unnatural quantity of oxygen thrown upon the lungs at the time^
which acted upon the animal with its well known stimulating powers.

The fact that the blood in the alligator circulates, whenever the ani-
mal chooses, without respiration, completely overthrows Dr. Cart-
wright's theory. To the objections urged against the theory, derived
from the cold-blooded animals, Mrs. Willard replies by simply saying,
that " there is too much difference between the circulation in a human
being and that in a fish or reptile, to enable us to reason from the one
case to the other." Mrs. Willard and Dr. Cartwright seem to have
forgotten this statement ; for now they declare that their theory is estab.
lished " beyond all doubt and dispute," by a single experiment made
upon the lungs of an alligator.

The case of the foetus, in utero, is equally fatal to their theory ; for
the heart of the child beats, and the blood circulates, with greater rapi-
dity than after birth, for several months, and that, too, in the absence of
all respiration, of course, and of all connection with the circulation of
the parent. This objection, so apparent to all, has been already pre-
sented to Dr. Cartwright, by his Boston opponents, to whom he has
made no reply. Mrs. Willard recognizes the objection, but briefly
passes over it by saying: " So different are the two conditions, (in
utero and out of it) that we cannot argue from one to the other." Ver-
ily, there is always some way left to get out of a difficulty !

We will close this paper by noticing briefly the following items and
positions assumed by Dr. Cartwright, in his last two papers in the Bos-
ton Medical and Surgical Journal :

1. He quotes from Cuvier the following passage, to prove that that
author supported the doctrine, "that the chief motive power of the
blood is in the respiratory organs." " The blood," says Cuvier, " de-
rives its heat, and the fibre its susceptibility of nervous irritation, from
respiration." Again, speaking of animals, he says : " Chacune de ses
classes jouit de la faculte de se mouvoir precisement dans le degre qui
correspond a la quantite de la respiration." Legons d* Anatomic Com-
pare, vol. 1, p. 52.

Dr. Ely on the Motive Power of the Blood.

How either of these quotations favor the new theory, is more than
we can discover. Admitting that the blood derives its heat from respi*
ration, il does not thence follow, that the chief motive power of the
blood is in the lungs ; nor do we believe that Cuvier ever thought of
such a strange theory. Heat produces motion every where we admit ;
but this is a very different thing from admitting that the expansive force
communicated, by heat, to the blood in the lungs, is sufficient to cause
the arterial circulation. We could say much on this point, but the thing
is too plain to need much argument. As to the second quotation, we
are equally at a loss to discover how the simple fact, that the respira-
tion of animals, being in some proportion to their locomotive powers*
proves the new theory. Cuvier dwells extensively on this latter sub-
ject, in his Anatomie Comp., and clearly points out the true relation be-
tween the respiration of animals and their faculte de se mouvoir. His
views on this subject are the same as those entertained by the most
eminent living physiologists of the day, and we will not therefore quote
him on the subject.

We see nothing in Cuvier, either in his Rdgne Animal or in his he-
cons aV Anatomie Compare, which justifies the statement of Dr. Cart-
wright, that " Baron Cuvier, the highest authority in natural philoso-
phy, brings the light of that science in support of the new doctrine, that
the chief motive power of the blood is in the respiratory organs." We
are astonished at this announcement, and can only account for it by
supposing that Dr. Cartwright has only glanced carelessly over the
works of Cuvier. That writer treats at large on the subject of the cir-
culation of the blood, and distinctly announces the cause of it. We
need give only one quotation. Speaking of the circulation and of the
arteries, he says :

" C'est a cet endroit ou les deux grands troncs communiquent qu'est place
le coeur, qui n'est autre chose qu'un organe dont les contractions poussent
avec violence ce fluide dans tous les rameaux du tronc arteriel. * * *
C'est dans ce mouvement de rotation que consiste la circulation du sang, qui
est, comme on le voit, une autre fonction d'un ordre secondaire propre aux ani-
maux, et dont lecoeur est V agent principal el le regulateur." Cuvier, Anatomie
Comp. vol. 1, p. 13.

How completely this contradicts Mrs. Willard's theory, will be ap-
parent to all. Mrs. Willard's theory, too, it will be recollected, sup-
poses the heat of the lungs to be greater than that of any other part of
the body, thus causing the blood to flow from them rapidly by expan-
sion. This is a fundamental principle in her theory ; for if the blood
is of the same temperature in all parts of the body, the expansion would
be equal in all parts, and in every direction, and consequently there

The New-Orleans Medical and Surgical Journal.

could be no circulation from expansion. The valves would not alter
the case at all; for the expansion and pressure would be equal and the
same on both sides of them. Hence the position of Mrs. Willard, now
endorsed by Dr. Cartwright, that the heat of the lungs must be greater
than that of the other parts of the body. This fundamental principle
Cuvier plainly contradicts:

"L'efFet immediate de la respiration est done de donner au sang sa qualite
arterielle. * * * Cet effet s'exerce dans le poumon

meme, puisque le sang devient subitement arteriel ; mais le poumon n'est pas
pour eela le lieu le plus chaud du corps, quoiqu'il soit la source de la chaleur
animal, parceque le sang arteriel a plus de capacite pour le calorique que le
venieux." Cuvier, Anal. Comp. vol. 7, p. 11.

We might make pages of extracts fyom the Lecons ef A natomie Com-
•parde, to show&h&t Cuvier does not " bring the light of science in sup-
port of the new doctrine, that the chief motive power of the blood is in
the respiratory organs," but these will suffice.

2. Taking Dr. Cartwright's propositions in the order in which he
presents them, the next is that regarding lymphatic hearts, which he
says he has discovered in the alligator. We have conversed with Dr.
Bennet Dowler on this subject. He has dissected great numbers of
alligators, and says that he has never discovered lymphatic hearts in
any of them, and that he does not believe in their existence. He thinks
that Dr. Cartwright must have mistaken something else for them. In
an alligator which was vivisected by Dr. Dowler on the 6th of May
last, in the presence of Drs. S. A. Cartwright, Copes, Hale, and many
others, Dr. Dowler and myself sought diligently for lymphatic hearts,
after ithe others had retired, but found nothing that could even be mis-
taken for them. Dr. Cartwright introduces this discovery of his as
having some bearing upon the new theory. We confess that we do
not see what it is. If any thing, it militates against it ; for the new
theory argues that hearts are quite insufficient to circulate the blood.
The respiration in the alligator is almost nothing,* and if we were
quite satisfied of the existence of lymphatic hearts, we would regard
;them as greatly confirming the old theory, now generally received.
(Cuvier, we believe, says nothing about lymphatic hearts in any of the

3. " Comparative Anatomy," says Dr. Cartwright, " has revealed
Reptilia, in his Regne Animal.

* Speaking of respiration in animals, Cuvier says : Plusieurs n'en ont
besoin aussi continuellement ; leur respiration a quelque chose d'arbitraire; ils
peuvent la suspendre plus ou moins long-temps, etc. ; ce sont les reptiles, etc.
Cuvier, Anatomie Comparee, tome 8, p. 1.

Dr. Ely on the Motive Power of the Blood.

the fact, that there are more than 12,000 species of red-blooded animals
having no muscular apparatus or heart to propel the red blood, and
about as many molusca having no heart to propel the venous blood, to
say nothing of three millions of species of insects without any heart at
all."

The advocates of the new theory are evidently interested in getting
rid of as many hearts as possible, and, as is very natural, they deceive
themselves. Let us first examine the statement, that " there are more
than 12,000 species of red-blooded animals having no muscular appa-
ratus or heart to propel the red blood." Dr. Cartwright alludes, we
presume, to the fourth class of vertebrated animals — Pisces. We are
disposed to question the correctness of the statement that fishes have
no muscular apparatus or heart to propel the red blood. Let us take
Cuvier's own account of the circulation of the blood in fishes : " The
blood," says he, "is brought to the gills by the heart, which thus an-
swers to the right ventricle of warm-blooded animals ; and from the
gills it is sent to an arterial trunk lying immediately upon the under
side of the back -bone, which trunk is the J eft or systemic ventricle of
the heart, and sends the blood throughout the body of the fish." Cuvier's
Animal Kingdom,^. 290, London edit., 1840.

Dr. Cartwright tells us that " Cuvier is the highest authority in natu-
ral philosophy;" we presume he meant to say natural history and com-
parative anatomy. Now it is evident, from the above quotation, that
Cuvier, at least, did not regard fishes as destitute of any muscular ap-
paratus for circulating the arterial blood. He declares that they have
a " left or systemic ventricle of the heart" — the arterial trunk on the
under side of the back-bone. The only difference between the heart of
fishes and that of the mammalia is, that in the former the left ventricle
is separated from the right. Cuvier furthermore states that this left
ventricle " sends the blood throughout the body of the fish."

Let us now look at the Molusca, which, Dr. Cartwright tells us, have
no heart to propel the venous blood. We will again quote Cuvier to
show that the Molusca are better provided with hearts than almost any
other order of animals. The poor oyster, so heartlessly devoured by
man, is far from being heartless himself, "The circulation of the Mo-
lusca," says Cuvier, " is always double — that is to say, their pulmonary
circulation always makes a separate and complete circuit; and this
function is always aided by one fleshy ventricle at least, placed, not as
in the fishes, between the veins of the body and the arteries of the lung,
but, on the contrary, between the veins of the lung and the arteries of
the body. It is, consequently, an aortic ventricle. The family of Ce-

50 The New-Orleans Medical and Surgical Journal.

phalopods alone is provided, besides, with a pulmonary ventricle, which
is even divided into two. The aortic ventricle is also divided in some
genera, of which the Area and Lingula are examples ; at other times
as in the remaining bivalves, its auricle only is divided. When there
is more than one ventricle, they are not united together to make a
a single organ, as in animals with warm blood, but they are often pla-
ced considerably apart, so that we may say there are several hearts."

We see by this that the circulation in the Molusca is well provided
for. There is at least one heart to circulate the arterial blood, and
sometimes several. The circulation, then, in these animals, does not
at all favor the theory of Mrs. Willard, for we have only the arterial
circulation to account for. We do not maintain, under the old and gen-
erally received theory, that the contractions of the left ventricle circu
late the venous blood.

Lastly, the " three millions of species of insects without any heart
at all." Here, again, Dr. Cartwright is at fault. He follows too
much the naturalists of the old French school. It was only a conjec-
ture of Cuvier that insects are destitute of circulation. He did not say
destitute of a heart, as Dr. Cartwright has it. He has but one line on
the subject. He simply states that insects have " a dorsal vessel occu-
pying the place of the vestige of a heart, but without any branch for
circulation." Cuvier has been dead just twenty years, and great ad-
vances have been made, since his time, in every department of science.
It is now known that insects have a decided circulation, as Cuvier's
commentators acknowledge ; and we are surprised that Dr. Cartwright
does not know this. During the life of Baron Cuvier, and his brother,
also a great naturalist, Frederic Cuvier, who died at Strasbourg in
1838, anatomists were much divided as to the character of the dorsal
vessel — some regarding it as a distinct heart ; and others, including
Cuvier, as not. Recent observations have decided the question. "Ac-
cording to Herold, the dorsal vessel is the true heart of insects, being,
as in the higher animals, the locomotive organ of the blood, which, in-
stead of being contained in vessels, extends through the general cavity
of the body. This heart occupies the entire length of the bulk of the
abdomen, and terminates anteriorly in a single artery, which is not
ramified, and which carries the blood to the head, whence it returns to
the abdomen by the mere effect of its accumulation in the head, to re-
enter the heart ; and it is in this that the entire blood of insects con-
sists, and which are consequently destitute of veins."* According to

* Cuvier's Animal Kingdom, Lond. ed., p. 471 ,

Dr. Ely on the Motive Power of the Blood.

M. Strauss, the abdominal portion of this organ is the heart, which is
divided internally into eight chambers, in the Cockchafer, separated
from each other by two convergent valves, wThich permit the blood to
be propelled forwards, but prevent its returning. The still more recent
observations of Bowerbank and of Charles Gustavus Carus, and some
others, confirm the views of Herold, and place the existence of a deci-
ded circulation in insects beyond a doubt, although it is of a nature
very unlike that of the higher animals.

Charles Gustavus Carus is a celebrated naturalist, who has received,
since the death of Cuvier, the prize of the Academy of Sciences of
Paris for his discovery of the circulation of the blood in insects.

4. Dr. Cartwright stales that " that the Annelides and many other
animals having a very active circulation, have no heart, either aortic or
pulmonary." We are surprised to see such statements as these ; but
one bent on upholding a theory, is apt to commit extravagances. We
have only to quote his favorite author, Cuvier, in order to overthrow
again his position. " In the Annelides," says he, "the blood is gen-
erally of a red color, and circulates in a double and close system of ar-
teries and veins, which have sometimes one or several hearts or fleshy
ventricles, tolerably well marked. Their blood circulates in a well-
defined system." Cuvier's Animal Kingdom, pp. 388, 390.

In regard to the lymphatic hearts in alligators, we can only say, that
we have examined not only the most eminent authorities, but we have
also examined the animal himself, without being able to find them. We
do not, though, say that the animals dissected by Dr. Cartwright in
Concordia did not exhibit lymphatic hearts. But be this as it may, the
existence of lymphatic hearts would be directly against the "new the-
ory." It is stated by the compilers of the Encyclojpedie d' 'Histoire Na*
turelle, and also, I think, by Lacepede and Lamarck, that some of the
reptilia have enlargements in the principal lymphatics containing a
\alve, but they regard them as mere enlargements around the valves.
Dr. Cartwright may have discovered some of these and dignified them
with the name of hearts.

Dr. Cartwright does not, we think, do entire justice to tbe profession,
and to the most eminent physiologists of the day, in ascribing to them
the idea that the venous circulation is performed by the contractions of
the left ventricle. There may be some who do, but they are few ;
but even that view of the case has more to support it than Mrs. Wil-
lard's theory.

That the heart is the chief agent of the circulation, in all animals, is
now generally admitted by all naturalists and physiologists. The heart,

52 The New-Orleans Medical and Surgical Journal.

in some shape, (for there is no prescribed form) is at all times indispen-
sable to the circulation and life of the animal ; while the breathing
apparatus is not so universally and indispensably necessary for life ♦
Many of the Reptiliacan live a long time without air, and their internal
structure shows a complete conformity with this abstinence from respi-
ration.

The great fact is, that the circulation of the blood begins with a
heart,* and ends with a heart. The circulation takes into its service the
lungs, after birth, not as a locomotive agent, a pumping apparatus to
aid the heart, but merely as a purifying and revivifying elaborator of
the venous blood, so that the heart may constantly throw to the tissues
a stream of liquid nourishment. That the lungs are secondary, is
proved by the fact, that their functions can, for a considerable time,
be dispensed with, by many animals, while that of the heart never can.

Cuvier, though a great naturalist, is full of errors. His statement
that the whole class of Insecta have no circulation, is a great error.
But, admitting this to be true, what becomes of "the new theory,"
which supposes the lungs were intended to be the chief motor of the
blood ? What is the office of the lungs, in the whole tribe of insects,
who, according to Cuvier, have no blood to circulate ?f

Dr. Cartwright seems to lay great stress upon the intimate relation
oetween the respiration of animals and their locomotive powers ; and
thence endeavors to derive an argument to support his theory, that
" the chief motive power of the blood is in the lungs." This curious
relation is specially noticed by all physiologists ; but Cuvier very justly
remarks, besides, that there is not a less intimate relation existing be-
tween the respiration and the locomotive powers, than between the res-
piration and the digestive apparatus. Those animals who have great
locomotive powers have an immense appetite, as well as great respira-
tion. Why may we not, therefore, by parity of reasoning, locate "the
chief motive powers of the blood" in the stomach ?

We are free to admit that there is much yet to be learned regarding
the circulation of the blood. We are not disposed to dogmatize, nor
to be tenacious of our opinions. We cultivate science for its own sake.

* In the foetus, in utero.

f " Deux classes nombreuses d'animaux sont entierement privees de circu-
lation dans des vaisseaux clos, et se nourrissent a la maniere des vegetaux, par
la simple imbibition d'un fluide qui baigne toutes leurs parties." Cuvier, Anat.
Comparee, vol. l,p. 14.

Dr. Taylor on Cholera in California.

Discussion aids in the development of truth and sound philosophy. We
trust, therefore, that Dr. Cartwright will continue his investigations on
the motive powers of the blood, in his usual able manner. Physiology
is, as yet, a very imperfect science, and those who think that they under-
stand it all, perfectly, are probably in error.

IX. — CHOLERA AS IT APPEARED IN CALIFORNIA — BARQUE
SPLENDID, &c.

Excerpta from my Note Booh.

BY W. TAYLOR, M. D., OF ALABAMA.

About the middle of October, 1850, we descended from the high
granitic crest of the Sierra Nevada to the low alluvial valley of the Sa=
cramento. On quitting the mountain streams and reaching the valley,
the traveller sees unroled before him a vast plain, receding until it van-
ishes in the far horizon.

Fresh from the salubrious influence of a mountain atmosphere, we
found ourselves breathing one dense and sultry, and saturated with
dust and impurity. At this season of the year all nature is dry, sere
and parched, and presents more the appearance of an arid desert than
a fertile valley. Neither hill nor cliff rises, to break the uniformity of
the wide-extended plain ; only here and there a lone tree, or occasion-
ally a bank, rising sensibly higher than the adjoining parts. These
banks abound in lime and fragments of sea-shells, and instinctively re-
cal to the mind the more ancient condition of the globe, when these ele-
vations were shoals, and the valley itself the bottom of a vast gulf, or
Mediterranean sea. And even now, the illusive phenomenon of the
mirage, which is common on these plains, almost deludes one into the
belief, that he is surrounded by a sea, or on the surface of a great wa-
tery mirror. All objects appear to hover in the air ; trees, cattle, hor-
ses and men, appear inverted in the atmosphere.

On reaching Sacramento City, we found that that dread scourge
Cholera, had just made its appearance, in more than an ordinarily ma-
lignant form. The panic was great, and well it might have been. For
never, perhaps, was a city in a better condition to propagate an epidemic
in all its malignancy. The situation of the town is low, and subject to

54 The New-Orleans Medical and Surgical Journal.

annual inundations ; the streets were filthy in the extreme, and the al-
leys and back yards filled with decaying vegetable and animal matter.
Sutter Lake, situated within the suburbs of the city, contained a vast
amount of stagnant water, dead and putrid fish, and all manner of filth,
which produced an intolerable stench. The atmosphere was close and
sultry, and void of electricity. Altogether, the city presented all the
conditions that one would think requisite for the disease to flourish in
all its horrors and mortality. And in addition to all this, as if to favor
its mortality still more, the blood of a vast majority of its victims, from
diet and habits of living, was, to a greater or less extent, in a scorbutic
condition ; and whenever this was the case, the disease was always
sure to prove fatal.

For the first few days after the onset of the epidemic, every case
proved mortal ; there was no instance of recovery for three or four
days. The first case of the epidemic that I saw in the city, was a pa-
tient of my esteemed friend, Dr. W. G- Proctor, who died in about six
hours after the attack. I treated several other cases afterwards before
leaving the city, but with very limited success.

In the meantime, I had engaged passage for Realejo, on the barque
"Splendid," of Boston, Harding master, which was to sail on the 28th
of October, The master offered me the Surgeon's place, which I ac-
cepted ; but in doing so, little did I suspect the immense labor that
I was assuming, or the melancholy sequel that was to follow.

The day set apart for the sailing of the Splendid arriving, I left the
city and boarded her in the capacity of Surgeon and Physician. The
vessel was to have been towed down to San Francisco by steam, but
owing to disappointment in getting a towboat, according to contract of
our Captain, it was not done. The disappointment was in consequence
of the engineer of the towboat having died of Cholera, on the passage
up the river, and the inability to get another in time to comply with the
engagement. The result was that we had to float down by the current
most of the way to Benicia.

The Captain was ill of a mild form of the epidemic when we went
on board, but the entire crew and all the passengers seemed to be in
good health, and but little complaint amongst them, considering the evi-
dent insalubrious state of the atmosphere, and the known prevalence of
the disease in the city. Under these circumstances, late on the evening
of the 28th, we weighed anchor and dropped down with the current, on
our way to San Francisco ; but we had scarcely gotten our anchor
clear, when I was summoned in haste to the forecastle, to seethe cook.
On reaching him, I found him laboring under a severe attack of Cholera

Dr. Taylor on Cholera in California.

—surface clammy and shrunk, great pallor, cramps, extremities cold,
and almost pulseless. Wishing to avoid the ill effects of a panic, after
giving him a heavy dose of anodyne and carminative medicine, I imme-
diately went to the mate, and had him conveyed to the shore, and sent
to the hospital, without letting the passengers know the nature of his
malady. At the same time, I ordered the chloride of lime to be freely
used in the hold of the vessel. After this, all went on well for about
thirty-six hours, when I was called to see a man by the name of J.,
aged about 32 years, whom I found voiding every few minutes profuse
rice colored discharges, features shrunk, surface cold and clammy,pulse
quick and frequent, but almost imperceptible, and violent and excrutiat-
ing cramps. Yet in this condition was he trying to walk about, and it
was with difficulty that I could induce him to take his bunk. Finally-
succeeding in getting him to bed, I gave him a portion of the following :

Tinct. Opii, § i

" Capsici, d i

" Camph. 5 i

" Kino, § i

Catechu, 5 i

Oil Carophyl, 3 i

Dose — A tea spoonful, repeated every fifteen or twenty minutes,
until the discharges are arrested, or the pernicious influence of the nar-
cotic became apparent. After this I administered full doses of Calo-
mel. To relieve the spasms, I administered Chloroform, in drachm
doses, repeated according to the urgency of the symptoms, with much
benefit. So potent and effectual was this remedy, in combatting this
symptom, that I never used it in a single case that its effect was not
immediate and happy— always relieving the cramps, and giving tem-
porary relief, at least, to the patient. After giving it to J. he revived,
and seemed comparatively free from suffering for some hours, but even-
tually sank, and died after an illness of about twelve hours. But be-
fore this event occurred, there were a dozen other cases, and the panic
with the passengers was complete ; all was confusion among them ;
terror, dread and consternation were depicted in the countenance of the
bold and firm, as well as the weak and timid. To such an extent were
they frightened, that it was with the greatest difficulty that I could in-
duce the well to nurse the sick, or give them any attention. To avoid
a monotonous array of cases, I would merely observe, that my general
practice throughout the entire course of the epidemic, was similar to
1 hal followed in the treatment of the case above alluded to, with what

The New-Orleans Medical and Surgical Journal.

success must bo hereafter determined. Warm baths, in which I placed
great reliance as a remedy in the treatment of the disease, from the im-
practicability of heating water in sufficient quantities on the vessel,
could not be commanded. Consequently, frictions and counter irritants
were the only substitutes. I had no medical assistant, and but an in-
different set of nurses ; under these circumstances, my task was not an %
easy one, and my situation any thing but pleasant.

Our vessel was eight or nine days floating and lodging on sand bars*
(not sailing) to San Francisco; and of her 130 passengers on board,
not more than eight or ten escaped the disease, in some form or other;
some experiencing it very slightly, while others had it more severely.
Of the whole number attacked, seventeen died. I was forcibly struck
with the great contrast of the disease, as it manifested itself on this oc-
casion, and the character that it ordinarily presented in the Valley of
the Mississippi. I could only account for such difference, by supposing
it to be the result of climatic influences. We know that not only plants
and animals, but disease itself, presents different aspects and characters
in different lands and climates. In our own temperate region, the Pal-
ma Christi (Ricini Communis) and the Cayenne Pepper, (Capsicum
Annuum) are annual plants ; while in the tropics they become peren-
nial shrubs. The effect of these influences on animal life is not less
marked and decided ; the same is true ofdisease. And in virtue of this
truth, perhaps, was the Cholera essentially different, as it appeared in
California, to what I had seen it in Louisiana twelve months previ-
ously. Indeed, so materially did it differ from the epidemic, as known
east of the Cordilleras and Rocky Mountains, that many of the best
Physicians were disposed to regard it as a different disease.

It may be proper to observe some of the characteristic differences in
the disease, as it manifested itself in California, compared with that
form of epidemic Cholera that I had seen and treated on the Ouachita.
In the disease as it appeared in California, there was, in many instan-
ces, an entire absence of vomiting and cramps, and some few, indeed,
did not experience any pain. The discharges from the bowels were
both frequent and copious, but in nearly all the cases the stools, instead
of presenting the characteristic appearance of rice water, in color andx
consistence, were of alight crimson, brown, or brick-dust color — as i
the ordinary rice water discharges had been charged with these different
hues, by the thorough incorporation of greater or less quantities of
blood, that had exuded from the entero mucous surface. J. and four
others were the only cases that occurred on the vessel, in which all
the symptoms of the genuine Asiatic Cholera were present. For a

Dr. Taylor on Cholera in California.

long time I was in doubt, and am not yet fully decided, whether to re-
gard the disease as epidemic Asiatic Cholera, modified by the universal
disposition in that country to inflammation of the intestines ; or whether
it was a malignant epidemic form of inflammation and congestion of
the bowels. Certain however it was, that its malignancy was in-
creased by an abnormal and insalubrius slate of the atmosphere* The
atmosphere at the time was thick and hazy, as if saturated with smoke
and dust, and almost an entire absence of electricity. Even those that
were well seemed dull and heavy, and indisposed to act ; all were low-
spirited and despondent. And, as if to add still more to the detriment
and discomfiture of the panic-stricken and ill-fated passengers, the air
was raw, chilly, damp and penetrating. The gloom on some occasions
was sufficient to unnerve the most stout hearted. I remember one
morning, after having been below in the hold all night with the sick,
trying to administer to their wants, I came on deck, and found our ves-
sel fast aground on a sand bar. The sun was obscured by the clouds,
and the winds blew bleak and damp, pregnant with disagreeable odors
from the dismal sloughs and marshes on either side of the river — all
nature seemed to frown ; and then, as if to add horror to the scene, and
make despair complete, the ear was pierced every moment with the
screams and groans of the dead and dying.

In nearly all the cases, previous to the attack, (a few hours only, or-
dinarily) there was a partial suppression of urine, and in some few in-
stances, I have reason to believe that I succeeded in arresting the dis-
ease, or at least mitigating it to a great extent, by the timely use of
diuretics. One case I will give in illustration : C. C, a stout, robust,
intelligent man, aged about 45 years, came to me with all the premoni-
tory symptoms, and with them, a total suppression of urine. I imme-
diately gave him a fu|l dose of Spts. Nit. Dulc, and advised him to go
to the medicine chest and take a dose of the mixture given on a preced-
ing page, with the further instruction to retire to his berth and remain
there quietly. Two hours afterwards I visited him again, and asked
him how he was getting on. His answer was, " Well, Doctor ; I did
not take the other dose that you prescribed, but the Nitre has made me
as straight as a pin, and I do not think it will be necessary to take any
thing farther ; my kidneys are acting finely, and I feel as if I would re-
cover without farther trouble." However, I was not willing to risk it,
and gave him a dose of Calomel and Dover's Powders ; it acted well ;
his symptoms all disappeared, and there was no recurrence of them. I
never lost a case of the disease when I could get free and consistent bil-
ious discharges.

&8 The New-Orleans Medical and Surgical Journal.

We reached San Francisco about the 7th of November. On reach-
ing the city, we made arrangements with the authorities as soon as
possible to remove some of our sickesfpassengers to the City Hospital.
We sent eight patients to it, three of whom died within twenty-four hours
after their admission. These three are included in the seventeen, the
sum total of the mortality, from the epidemic on the vessel.

After reaching the Bay of San Francisco, and coming under the in-
fluence of the seabreeze, we had but few new cases of the epidemic.
With the exception of myself and one or two others, there were none.
Iwas taken quite violently with the disease the morning after we an-
chored in the port, but it yielded readily to medicine, and I was up
again in a few days. What is remarkable in my case is, that I should
have exposed myself to the disease so constantly, and mingled with it
so much, and yet be about the last to take it. My labor during the
whole trip down the river was incessant — waiting on the sick day and
night for ten days in succession, during which time I did not sleep, in
the aggregate, eight hours.

We remained in San Francisco until the 11th of November, when
we weighed anchor, unfurled our sails and cleared port, and were soon,
once more, on the bosom of the Pacific, on our way to Realejo. We
had no more of the epidemic on board after we got out at sea, but had
several cases of Typhoid Fever, of which two passengers died, and
several others escaped very narrowly.

%. — CONTRIBUTIONS TO EXPERIMENTAL PHYSIOLOGY.

BY BENNET DOWLER, M. D.

Corresponding Member of the Academy of Natural Sciences of Philadelphia ;
Fellow of the Medico-Chirurgical College of the same city, &c, &c.

May 6th,— 3 P. M. to G P. M., — 1852.

VIVISECTION NO. 1.

By the politeness of Dr. Cartwright, I was called upon, by letteiv
this evening, to make arrangements for the vivisection of an alligator,
which he placed at my disposal. I accordingly called at his house to
inform him that I would attend on the following day ; but after reflect,
ing upon the matter, I thought it advisable to proceed in the vivisection

Dr. Dowlek's Contributions to Experimental Physiology. 59

without delay, although unprovided with suitable instruments.* In a
few minutes after the operation began, several medical gentlemen ar-
rived, though not all at the same time : Drs. Greig, Coit, Reynolds, Mr.
Gordon, and at a later period Dr. Weatherly.

1. The alligator, over 3^ feet long, was vigorous, and disposed to
fight and resist.

2. It was secured by bandaging its muzzle and tying its body to a
plank, the back down.

3. The trachea was firmly tied in the middle of the neck with a
piece of tape.

4. In a few minutes the animal appeared to be dying. The cords
were untied, those of the mouth excepted. Death appeared complete
in thirty minutes. In the meantime, the viscera of the chest and ab-
domen had bep-n exposed. One of the hind legs was dissected— the
skin and facise removed — the muscles separated, and the sciatic nerve
and its branches, to the popliteal region and down to the ankle, was
pinched, disorganized and cut, without any signs of pain — without vo-
luntary motions, and without convulsive action, excepting the usual
twitchings, chiefly in the toes [which I have so often described as tak-
ing place in the apparently dead animal, for a period, sometimes, from
one to three days, and even in amputated limbs. These twitchings
do not appear, in any case to amount to complete extensions or
flexions].

All of a sudden the alligator came to life. This was about half an
hour after tying the trachea, the ligature still remaining. The limbs
had been relaxed — the body motionless for some minutes. But in the
twinkling of an eye it turned upon its abdomen — jumped from the table
to the pa.vement, and without attempting to run away, faced the com-
pany— took an attitude of defence — struck at every one that came

* Since writing the above, I have performed some, and reviewed other ex-
periments made with what would be regarded, at first sight, as suitable instru-
ments— instruments which are probably the worst, as sharp knives, keen chis-
els, etc. In the present instance, the use of a dull case-knife, probably pre-
vented, in a good degree, profuse haemorrhage, which is always unfavorable to
striking results. Franklin, who knew the unaffected simplicity of Nature, ap-
proached her portals, and learned her profoundest secrets, by means of a kite,
a key, a flask, and a few plain instruments, which would make but a sorry ap-
pearance amid the glitter and magnificence of a mordern laboratory. With his
kite — an object of ridicule to the ignorant — he discovered how to disarm the
thunder-bolts of heaven.

The New-Orleans Medical and Surgical Journal.

nigh, as if intending to bite ; though fortunately for its enemies, its
jaws were still firmly bandaged together. It watched the vivisectors
narrowly, and turned courageously upon any one who advanced nearest
to it.

6. AH signs of death having thus suddenly disappeared, it was de-
termined, after ten or fifteen minutes' delay, to recapture it, and re-bind
it to the plank for further experiment, the trachea being still tied, as at
first.

7. After many attempts with a dull case-knife, used as a chisel, aided
by a hammer, the spine with its cord was divided in the middle of the
neck — several of the cervical vertebrae were broken so that a thumb
could be passed between the ends of the cord. By this method of ope-
ration, some of the great muscles of the neck were biuised and even
completely disorganized, thereby preventing, in a great degree, motion
in the head and neck. Much blood was lost, though this animal has
comparatively but little,

8. The viscera were more fully dissected. The ligature was at
length removed from the trachea. The latter having been opened, the
lungs throughout the subsequent stages of the vivisection were repeat-
edly inflated by Dr. Cartwright's black boy. In detaching the lungs,
or from some other cause, a rent had been produced, from which the
air escaped,* though this occurred at an advanced stage of the dis-
section.

At intervals the dissection of the legs was continued, by which the
skin and fasciae were removed, the muscles separated, the nerves ex-
posed, pinched, crushed, cut and removed.

9. By means of a rusty wood saw, the spine, with the cord, was
divided a second time, midway between the fore and hind legs in the
lower third of the dorsal region, so that the body could have been dou-
bled in three pieces like a pocket-rule, connected only by the skin and
muscles.

10. Most of the viscera were removed from the body. The remain-
ing nerves of the limbs were exposed, experimented on, and cut
away.

* One of the medical gentlemen who was present informed me, that this rent
was caused by the black boy, who inflated the lungs with undue violence.
These organs,Jndescribably delicate and beautiful, consisting of small transpa-
rent bladders without parenchyma, are easily ruptured. When compressed so
as to exclude the air, and dried upon glass, they form a fine microscopic ob-
ject, but little thicker than paper in an animal from one to three feet long.

Dr. Dowler's Contributions to Experimental Physiology. 61

11. Finally, from the last division of the spine a punch was intro-
duced into the canal, by which the cord was gradually but completely
destroyed downwards to its caudal, and then upward to its cervical
portions.

12. From the first to the last division of the cord — from the resusci-
tation to the close of the experiments, the threefold division of the body
made by the two sections of the cord, displayed in all three of its parts,
both sensation, volition, and accurately adapted muscular motion. The
eyes winked or nictated. The head, towards the close of the experi-
ments, attempted to bite Dr. Reynolds. The lumbar and caudal divi-
sion gave the most unequivocal indications of pain, contrivance, and
adaptative action. Thus the animal, on being suspended by the neck,
so that the legs might hang down, was pricked with a scalpel in the
groin, whereupon it raised one hind leg, (the other had been amputated)
it carried the foot (the law of gravity opposing) instantly and accurately
to the exact spot where the injury was inflicted, pushing strongly
against the knife, slightly wounding its ankle in the attempt to remove
the pain-giving instrument — a feat requiring extreme flexion — a com-
plete doubling of the leg upon the thigh. Now this flexion, and several
others performed near the close of the experiments by the remaining
hind leg and by the fore legs, took place not only after two divisions of
the cord, but after the removal of the individual nerves in the limbs
themselves, and after the removal of the viscera and the principal por-
tion of the sympathetic nerves, plexuses and ganglions. These motions
indicated sensation and volition, as truly as those of the undivided nor-
mal animal. In the divided, eviscerated animal, with its limbs deprived
of its nerves, clear indications of pain and combined motions took place,
when, at the close of the experiments, the divided ends of the cord were
touched. Thus, when the dorso-caudal part of the cord was irritated,
the hind leg was strongly directed to that place. This it repeated until
the entire cord was gradually destroyed by a punch reaching down to
the tail. The same phenomena occurred when the punch pressed or
disentegrated the cord, from the last, or dorsal division, upwards tow-
ards the head or cervical division.

13. In the dissection of the nerves of the limbs during and after the ap-
parent death — after the first and second divisions of the cord, and after
amputation, a certain peculiar kind of muscular twitching, particularly
in the fingers and toes, took place from compressing or injuring the
nerve-cords (as I have formerly described) ; slight compression produ-
ced many twitches — a strong disorganizing one, or a section gave one
or two only, after which compression in the same place produced no

62 The New-Orleans Medical and Surgical Journal.

motion whatever. The motion could always be reproduced whenever
a new portion of the nerve was selected, provided it was invariably
upon the distal side of the disorganization or section. The proximal
end, that is, the end connected with the cord, when thus treated, was not
succeeded by any motion, while that of the distal portion rather aug-
mented as the irritation approached the extreme distribution of the
nerves upon the fingers and toes. When the nerves were uninjured in
any way, these twitchings were no greater than after the section of the
nerve or the amputation of the limb. These twitchings seem totally
void of volition or adaptation, being equally independent of the cord and
of the proximal end of the nerves.

It will be seen that in the preceding experiments numerals have been
used, in conformity to the stages of the vivisection. These are prefixed
to the paragraphs for the convenience of the witnesses, who may have
arrived at different periods. It will be seen by the certificates, at the
bottom of the page, that Drs. Coit, Reynolds and Greig saw all the ma-
terial experiments, beginning with paragraph 7, and thence to the end.
Dr. Weatherly does not mention particulars, as will be seen.* This
report has not been changed or added to since it was read to, and ex-
amined by, these gentlemen, with the exception of two foot notes.

VIVISECTION NO. 2.

The following Programme was submitted to the gentlemen present
before the vivisection was commenced. The answers to the interroga-
tories of this Programme, as given by this experiment, and by many
former experiments incomparably more striking, varied, prolonged,
and perfect, will be annexed in the categorical form of affirmative or
negative, within brackets, unaccompanied by explanations, though pre-
lusive of experimental details that follow. This animal lived, compar-
atively, a short time. The weather was hot. Judging from experi-
ments made in the cool season, I suppose that it would have lived at
least three or four times longer, had the vivisection been made in the

* We fully agree with Dr. Dowler as to the correctness of the experiments
which we witnessed, from paragraph No. 7.

J. J. COIT, M. D.

D. ELLIOTT REYNOLDS, M. D.

ALEXANDER GREIG, M. D.

I saw a portion of these experiments, and so far as I witnessed them they are
correct.

J. R. WEATHERLY M. D.

Dr. Dowser's Contributions to Experimental Physiology. 63

winter. The rapid haemorrhage, for which no ligatures could be used,
was another most unfavorable circumstance. I had never before divi-
ded the spinal canal with a sharp chisel, having generally used hatch -
ets, saws, or dull instruments, whereby hemorrhage was in a great de-
gree prevented. In decapitating with a dull hatchet, the great carotid
is sometimes, though rarely so contused or compressed by a sort of tor-
sion, that a ligature is not required. Furthermore — The animal had
been prepared for vivisection for four days before it took place ; during
this long delay it was constantly and strongly bound with numerous
cords, from the tip of the muzzle to the tip of the tail, including the
limbs. I found, upon subsequent dissection, that portions of the mus-
cular tissue had been injured by the cords. This constant pressure for
four days, doubtlessly, impaired its muscular activity.

I subjoin a small portion of the measurements : From the tip of the
muzzle to the central interspace of the orbits, 5 inches; to the occiput, 7;
interscapular, 11^; sacro-iliac, 25 ; caudal extremity, 56 ; circumfer^
ence of the thigh, 1\ ; of the body, 21.

Programme of the Vivisection.

1. Divide the cervical cord: Will each division continue to manifest
sensation and voluntary motion ? Will each division act in concert or
simultaneously on irritating either at, near, and remote from the line of
division. [Ans. Yes.]

2. Divide the lower dorso-lumbar cord : Will all three parts af*
terwards manifest sensation and voluntary motion ? Will two or three
act simultaneously for a common end, where the middle or extremities
are injured? [Ans. Yes.]

3. Dissect the brachial plexus of nerves from a fore-leg ; Will
voluntary motion and sensation still continue to manifest themselves on
irritating the axilla, and the dorsal and cervical ends of the cord ?
Will the bare dissected muscles, if pinched or pricked, contract ? [Ans.
Yes.]

4. Destroy the principal trunks of the sympathetic : Will this dis-
section excite or destroy sensation and voluntary motion ? [Ans. Dis.
section excites these, but the destruction of the ganglions and plexuses
of the sympathetic does not appear to hasten their extinction. See Dr.
Dalton's very interesting experiments accompanying this paper. Dr.
Dalton must have cut away the chief part of the splanchnic nerve, toge-
ther with the solar, coelic, hepatic, gastric coronary, splenic, mesenteric,

64 The New-Orleans Medical and Surgical Journal.

renal, spermatic, aortic, and cardiac plexuses, as well as numerous
ganglions.]

5. Dissect the spinal roots of that part of the cord which gives off
the nerves to the hind legs : Will irritation of the posterior or the sup-
posed sensory root not be wholly devoid of muscular action ? [Ans.
No.] Will irritation of the anterior or so called motor root, afford sen-
sational or other phenomena like those of the posterior root ? [Ans.
Yes.]

6. After destroying the spinal roots, remove the corresponding por.
tion of the cord : What effect will pricking and pinching at the groin
produce ? [Ans. Voluntary motion, if I remember rightly ; but in for-
mer cases, this most certainly took place.]

7. Dissect, pinch, tie, cut, and disorganize the ischiatic or sciatic
plexus, and trace the sciatic, the popliteal, anterior tibial and peroneal
nerves. Prick and compress the isolated muscles : Will they not
twitch equally with and without the nerves ? — with and without connec-
tion with the cord ? [Ans. Yes.]

8. Amputate a limb : Dissect away its nerves, prick and compress
its muscles, will not the contractions be equally active as before ? [Ans.
Yes.]

For the following notes, written at the moment the events which they
record took place, I am indebted to my learned friend, Albert Welles
Ely, A. M., M. D. The portions which I have added are included
within brackets.

Vivisection of Alligator at Dr B. Dowler's, on 13lh May, 1852, at 9£ A. M.

Present : Drs. S. A. Cartwright, Hale, McKinley of Tigerville, B.
Dowler, Nutt, Ely, Copes, Bennedict, Coit, Reynolds and Weatherly.

Temperature of room, 79 ° F. ; of the animal 75 ° . He is just
from under the hydrant. [The hydrant water being 70 ° , the animal's
heat has not yet reached that of the air, which it would soon reach, as
former experiments prove.]

At 9 h. 20 min. A longitudinal incision just before the shoulders,
about 3 inches long in the back of the neck [the muscles and skin thus
divided were held asunder]; a half inch chisel was introduced, by
which the cervical canal and cord were divided [at the 5th vertebrae].
The haemorrhage was most profuse. All the gentlemen present having
inserted their fingers into the wound, were satisfied that the spinal
canal was divided ; a piece of sponge was inserted between the verte-
brae. [The copiousness of the haemorrhage seemed to indicate a divi-
sion of the great carotid, (which is single, and which lies close to the
anterior surface of the vertebrae) but the subsequent dissection, which

Dr. Dowler's Contributions to Experimental Physiology. 65

was continued seven days, showed that no artery but the vertebrals had
been cut.] This fl rst division of the spine produced no change in
the pupil of the eye [the iris being responsive to the light], Eyes en-
tirely natural, as before the operation. No change in the sensation of
the parts below or above the division. The application of the point of
a knife produced rapid motions in the head and all parts of the body,
just as before the operation.

Division of the spinal cord in the dorsal region at 10 o'clock and 25
min., by means of a chisel. [The spinal canal was divided through the
14th dorsal vertebra, that is, at a distance of 7 vertebrae from the first
lumbar.] Still the animal moved all parts of the body, even the head,
eyes, and tongue. It tried repeatedly to bring the fore paw to the point
where the chisel was inserted. Motion in all parts of the body was si-
multaneous. On inserting a probe into the canal, the animal moved
all parts of his body as before. These motion were the same when
the probe was inserted into the upper or lower portion of the divided
spine. The application of heat caused motions in all parts, the animal
always endeavoring to place his fore paws on the part heated. The
pupils of the eyes began to dilate after making the second division of the
spine. The animal closed his eyes at 10, 7 min., A. M.

At 5 minutes before 10, a long incision was made in the region of
the spine, immediately between the hind legs, during which the fore legs
continued to move, directed to the incision making. The pupil, during
the dissection of the muscles, in this last operation, became enormously
dilated. The narrow vertical slit or line of half an inch in length, na-
turally constituting the pupil in its contracted state, became a perfect
circle. Some of the motions of the hind legs and tail were convulsive,
while those of the fore legs and head were voluntary. At a quarter
past 10 the head appeared to be perfectly dead, but the fore legs moved
occasionally, [in a voluntary manner] as the dissection proceeded. On
pinching the skin and muscles of the head, no motion followed ; but on
pinching or touching the shoulders immediately below the division of
the cervical cord, the head moved to the side touched, and the fore legs
both moved also. On making the touch on the opposite shoulder, the
head invariably moved in the other direction, that is, towards the side
touched or irritated.

The dissection was continued down so as to expose the spinal cord,
and the posterior roots covered by the theca, which, in the alligator, is
black. On touching the posterior root, motions took place in the hind
legs on both sides, and in the fore legs. Also the tail moved with force
from side to side, as when the animal was operated on. The motion

The New-Orleans Medical and Surgical Journal.

of the tail was evidently voluntary. [On touching the cord as well as
posterior roots, both limbs usually twitched ; this twitching occurred,
too, in the right, as well as in the left leg, when the posterior roots of
the left side were irritated. The opening of the cord, always difficult,
often destructive to the posterior roots, and even to the texture of the
cord, was in this case, after some delay, happily accomplished. Hey's
saw, chisels and knives were used on both sides of the spinous pro-
cesses, by which a narrow, vertical, but deep stratum or section of the
muscles at their origin, was taken out from each side of these processes,
and then, along with the spinous processes, a narrow longitudinal strip
of the vertebrae themselves was removed, thereby exposing the cord,
as covered by the dark, yet semi-transparent theca. This slit in the
bony canal was, of necessity, too narrow for the perfect exposure of
the anterior roots, bat was, for this very reason, (as I had learned from
experience, not from writers) all the better for the satisfactory experi-
ments upon the posterior roots. The difficulties and disorganizing
effects of this operation have not been properly estimated. To say
nothing of the section of the muscles (the true motory organs) the
posterior roots must suffer injury, and ?.ven sometimes complete disor-
ganization, if a portion of the canal of considerable width be removed;
for then the sawing and chiseling of the bones must take place at the
very points where the posterior roots emerge ! The narrower the por-
tion of bone cut out, the greater the safety to these roots, and the less
the chance of making experiments upon the anterior, particularly in
small animals, the usual kind selected, as frogs, rabbits, kittens, etc*
That a wide strip of the spinal canal can be cut out of small animals,
so as to afford in the same case and at the same time a good view and
a free manifestation of the cord and its nerves at their emergence,
without injury to the posterior roots, may well be doubted ! Here, I
venture to think, lies much of the history, and not a little of the mystery*
too, of the supposed absence of motory excitation by means of the pos-
terior roots. The injury of these roots, the section of many muscles,
and the like, are lost sight of, for a theory.*

In the present experiment, the two objects sought were achieved, or

[* I beg leave to suggest the following rule for operating on the spinal roots,
namely — let two animals be always sacrificed for the double experiment. In
the one, intended for the demonstration of the posterior roots, let the opening be
narrow ; in the other, wider. With even this precaution, the posterior roots
will often be injured by concussion, etc., etc. I would like to see the operator
who can cut the anterior roots without injuring the posterior.]

Dr. Bowler's Contributions to Experimental Physiology. 67

rather verified, namely — that of showing, uninjured, the posterior roots,
and proving that they are motor, as fully as any other part of the ner-
vous system. The twitchings of the limbs were as distinct when these
roots alone were touched, or compressed, as when the cord was
touched, and the anterior roots torn. After destroying and scraping
away the cord, the twitchings were as great as ever ; as when an
instrument was scraped along the sides of the canal, so as to impinge
against the remnants of both sets of roots, where they emerge from the
canal ; while on descending, peripherally, from the canal, after the de-
struction of the cord, the twitchings became more distinct with every
removal from the centre. Still more : after destroying every visible
nerve, the muscles on being compressed gave twitchings, precisely sim-
ilar to those which had been excited through the nerves.]

At 25 minutes to 11, the sciatic nerve was exposed, the animal mov-
ing the hind legs as the knife divided the muscles. At the same time
the two musk glands were dissected from the lower jaw, during which
the fore legs moved voluntarily. Next the chest and abdomen were
laid open, during which all parts, except the head, moved voluntarily,
particularly the fore legs, which continued a pawing motion. The
heart was slowly dilating and contracting. At 10 M., to 11, the lungs
were artificially inflated, when the heart assumed a more powerful ac-
tion, and the animal exhibited signs of coming to life. The throat di-
lated, the animal attempting to breathe of his own accord, and the head
and legs moved. The sciatic nerve being tied, on pinching it gently
below the ligature, the limb contracted as often as the experiment was
made.

[In this, as in all other experiments, irritation or the pinching of a
nerve in any part of its course, produced no effect upon the proximal or
inner part of the nerve, nor on the muscles, whether the connection
with the cord were preserved or severed, affording an invariable physio-
logical law precisely opposite to that laid down in the most recent works
on physiology : Messrs. Kirke and Paget, say for example, "that when
the distal portion of the divided nerve is irritated, no effect appears."
(Phys. 289.) "No muscular action follows irritation of the posterior
roots." (Morton's Anat. 508.) In this, but far more in many other ex-
periments, it is proved that sundry divisions of the cord and of the plex-
uses and ganglions of the sympathetic, do not prevent sensation and
voluntary motion, all parts of the body acting in concert for a common
end, simultaneously, intelligencially. Here, again, the newest and best
works repeat, that <{ the cerebellum is the regulator of the locomotive

08 The New-Orleans Medical and Surgical Journal.

actions ;" (Todd on the Brain, &c.) a proposition quite incompatible
with the phenomena already enumerated.]

Search being made for "lymphatic hearts," none were found. (Here
Dr. Ely's notes end.)

A few minutes after noon, the gentlemen having gone up stairs to
take some refreshments, I continued the experiments. I repeatedly in-
flated the lungs, for perhaps half an hour, without any marked effect.
The death of all the tissues appeared to be going on with progressive
but unusual rapidity. The action of the heart declined perceptibly. I
ascertained that the swelling of the larynx, noticed in Dr. Ely's notes,
was not owing to an effort of the animal to breathe, but was caused by
a regurgitation of the air that had been forced through the artificial
opening in the trachea, made for the inflating process, and which did
not readily escape through the small glottidian slit of the larynx.

At 1, P. M., Dr. Ely rejoined me, at which time the twitching of the
limbs, from irritation of the nerves and muscles, continued unimpaired.
At half past 1, P. M., the experiments having ceased, the animal was
placed under the hydrant, and irrigated for half an hour, and then it
was immersed in a saturated solution of salt, for anatomical examina-
tion.

I regret that a want of space prevents me from inserting, in exlenso,
a recent communication, kindly sent me from the elegant pen of Dr#
Dalton. The following extract will be read with interest: "Lieute-
nant, now Capt. John C. Casey, U. S. A., and myself were walking
(I think it was in 1830) near the shore of Lake Pontchartrain, some
half a mile westward of the Fort, when we saw an alligator, four or
five feet long. We captured him, and then I proceeded to open and
eviscerate the entire contents of the thoracic and abdominal cavities His
heart, which we took to our quarters, continued its double action of sys-
tole and diastole for hours. From 24 to 26 hours after, I found the
alligator alive, and when I approached him and touched him with a
stick, he made a vigorous fight at me."

Having given a faithful detail of the two most recent experiments
that I have made, may I not be indulged with a few remarks, more or
less elucidatory of the general doctrines which they suggest ?

It is admitted that alligators, from their anatomical conformation and
psychical endowments, are better adapted for physiological experiment
than any animal of the cold-blooded class— a class most relied on for
these purposes, because their tenacity of life admits of a prolonged ex-
amination— a thorough analysis and separation of organs, and conse-

Dr. Dowler's Contributions to Experimental Physiology. b'9

quently a satisfactory appreciation of functions. All that can be ob-
jected against these experiments, then, as illustrations of comparative
physiology, applies a fortiori, to animals that are less analogous to
man.* That a double section of the spinal cord, cervical and dorsal;
that the removal of the nerve trunks of the limbs, and the destruction
of the sympathetic nerve, would hot remove all traces of sensation and
voluntary motion in man, I am not prepared to deny. Nor am I fully
prepared to take the affirmative, with all the assurance that precise ex-
periment and careful observation could possibly supply. I have, indeed,
observed in some warm-blooded animals, that the trunk, after decapita-
tion, manifests for a short time both of these fundamental functions,
while, I have observed for hours, in human subjects after apparent
death, so many physiological phenomena, which I once thought impos-
sible, that I am prepared to believe a good deal more. * * *

In man, paralysis of sensation and motion often rapidly follow certain
lesions of the nervous system, while at the same time these same func-
tions may survive, in other cases of injuries of a very extensive and de-
structive kind ; moreover, in a very great number of instances, these
functions are lost, without leaving any trace of disorganization discover-
able by the morbid anatomist.

The prevalent theory of the nervous system is not only erroneous in
itself, physiologically and pathologically considered, but it is, it may
reasonably be supposed, mischievous in practice. Muscular diseases
are called and treated as nervous, and although in many cases the treat-
ment is right, the supposed cure of the nerves is probably referable to
the muscular system, in which the morbid actions often are as evident
as any facts can be, as in cramps, tetanus, hiccup, subsultus, chorea,
convulsions, hydrophobia, hysteria, epilepsy, abortion, tenesmus, para-
lysis, stricture, rigidity, spasmodic contractions, strabismus, wry-neck,
&c. How all these, and many other kindred diseases, which present

* The psychical and personal history of alligator No. 2, familiarly called Zip
Coon, for two years, I may on a future occasion publish, showing his habits,
passions, seeming power of fascination, and most of all, his apparent foresight
of, and new contrivances against, the two extraordinary cold spells of the last
winter. Happier than the Crocodilcc of the sacred Ganges, the classic Nile, or
the turbid Mississippi, instead of dragging a useless life for centuries in the
swamps, he died in the cause of physiology.

Happy ! to whom this glorious death arrives,
More to be valued than a thousand lives !
On such a theatre as this to die,

For such a cause- Waller.

TO The New-Orleans Medical and Surgical Journal.

material phenomena or symptoms in the muscular organs, can be seen
in the nervous centres, or in the periphery, especially in those multitudi-
nous cases where no changes can be detected, either symptomatically
or anatomically, before or after death, would seem a more extravagant
pretension than that of clairvoyance itself, as the latter only affects to
see what is. The neurologists of our day, not satisfied with the Culle-
nian nosology, which assigns to the class of Neuroses, or nervous dis-
eases, a formidable host of species (" quel nombre prodigieux d'ene-
mis !"), but they would add even our epidemics, as yellow fever, to the
catalogue !

Hamlet. Nothing is
But what is not.

It is not intended, however, to dwell, in this place, upon the patholo-
gical method of illustrating physiology.

Revenons a nos Crocodiles. As to the above mentioned vivisections,
especially No. 1, it may be safely affirmed that so far as the natural
language of brutes can be accredited as defining consciousness, feeling,
volition, purpose, and self-determining motions, nothing is dubious —
nothing unsatisfactory — nothing to be desiderated. Explanation may
exhaust itself — expositors may dread and reject unwelcome consequen-
ces. The central sensorialist may rail at all parts of the system except
the nervous, as being unfit for the soul's seat — as unfit for knowing, will-
ing, feeling and acting. He can believe most steadfastly in an un-
known, unfelt spot in brain, which he calls the sensorium, to which
all the residue of the system, even the nervous, is but a mere passive
conductor ; he finds no difficulty in believing in a nervous circle, in
four distinct, yet wholly hypothetical sets of nerves, a double set, the
sensori-volitional, and yet another double set, the excito-motor ! But
on the other hand, how obstinately can he disbelieve that the mind, or
psychical entity, can, by any possibility, occupy the muscles, or take
even a temporary refuge in them, after the destruction of the nerves,
although the former surpass the latter in delicacy and exquisiteness of
organization, in adaptational contrivance, and in weli developed finality,
almost as much as a race horse surpasses an oyster in the locomotive
apparatus !

It may be further remarked, that the analogies of Nature — develop-
mental, progressive, comparative, physiological and anatomical, so far
from teaching that the nervous skeleton is the sole starting point, the
fundamental type of life and voluntary motion, teach just the contrary.
Nature travels far, surmounts innumerable physiological obstacles,

Dr. Dovvler's Contributions to Experimental Physiology. H

mounts high in the scale of organization, and achieves motiferous and
sensiferous Systems, before she admits a nervous system at all. In
plants, and in certain animals wholly destitute of nerves, both motion
and sensibility exist in various degrees.

Plants sleep, wake, move, contract, and possess a kind of sensibility,
without having a nervous system. Irritation, pinching, pricking, a drop
of acid, an unaccustomed heat, or the slightest touch, will suffice to
cause some plants to move. In a word, says Dutrochet, they will
comport themselves as animals would in like case : " En un mot, la
feuiile se comporte comme le ferait, en pareil cas, un animal qui serait
averti par ses sensations de l'actuelle d'une Cause excitante sur ses or-
ganes." (Mem. surles Vtgitaux. Tom. 1. 538. Art. xi. De Pexcita-
bilite vegetale et des mouvemens dont elle est la source.) The mimosa
pudica, (Lin.) or sensitive plant, affords an example of vegetable, anal-
ogous to animal contractility, being wholly independent of nerves. A
violent impression produces greater contraction of the plant, and a more
rapid exhaustion of its contractile force than a slight one. During the
repose of the plant, this force is renewed. Some plants are easily
poisoned. Here identity, rather than mere analogy, is obvious.

A greater error in physiology never prevailed than that now almost
universally recognized as a fundamental truth, namely, that the whole
of man, his entire Ens is but a bundle of conducting nerves, or rather
a minute unknown sensorial spot or centre. If teleology, or the doc-
trine of final causes, as explained by exquisite organization, by unmis-
takable adaptation, by the harmonious union of means and ends, and
by physiological anatomy, be regarded, then the muscular may, in at
least several respects, claim precedence over the nervous system. The
latter is not, as it has been seen, even the essential condition of life,
much less is it life itself, its entire ontology. Nor is it proved to be
the whole of man ^ nor his sole psychical entity and instrument. In
the human subject recently dead, the nerves exercise no influence for
or against muscular contraction. The latter being both active and in-
dependent.

The motions above described, be it remembered, had not a single
characteristic strictly " automatic," the pertinacious and pernicious as-
sertions of celebrated book-makers (and certain automatic critics, who
always think with the celebrated) to the contrary notwithstanding.
Even though an author were a Nardac of the Empire, (the highest and
most celebrated of all titles known in Lilliput) this would not give va-
lidity to opinions in physiology, while direct experiments prove these

72 The New-Orleans Medical and Surgical Journal.

opinions to be erroneous. The Academician who proposed to build
houses from above downwards, would be a fit companion for those the-
orists who thrust in the words "automatic," "reflex," "instinctive," and
so on, as a good explanation of the phenomena which I have so often
described as occurring in animals after decapitation — after sections of
the cord — after the removal of the nervous trunks — after the destruction
of the sympathetic system — after the removal of the viscera. Not only
so ; the word " automatic" is as much applicable to the composition of
the Iliad, or the movements of a dancer, as it can be to those functional
contractions, flexions, and extensions, which I have observed in an al.
most countless number of experiments, made directly upon human sub-
jects, soon after the infallible signs of ordinary, not physiological death,
had taken place. These, more numerous, curious and instructive, than
any I have observed in vivisection properly so called, are the very re-
verse of " automatic" or mechanical motion, and clearly overthrow the
received theories of the nervous system — of the reflex action of the
cord, and of the spinal roots.* Although I have published many of these
experiments, and many of the purely physiological laws thence derived,
the tenth part has not yet been told. The muscular system (not to
name the co-ordinate functions, as the capillar)7, calorific, &c.) pre-
sents, in these experiments, many curious laws, in relation to the incre-
ment, decrement, temporary decline, regeneration, persistence, injuries
and general conduct of its forces, which, though very variable, admit^
nevertheless, of scientific classification into groups.

* Bell describes the motions produced by irritating the posterior or so called
motory roots, as barely visible to the natural eye. Magendie says they are but
slightly marked — "Ces contractions sont cependent peu marquees," being, as
he says, infinitely weaker than those resulting from the touching of the cord
itself- Neither of these experimenters appear to have known, that after the
destruction of these roots, the motions augmented towards the periphery, from
irritating the trunk of the nerve, and even from irritating the muscles after the
removal of the nerves. Of course, these facts are completely subversive of
the theories which these gentlemen have deduced from their experiments upon
the spinal roots, not to name the reflex theory, more recently revived and advo-
cated by others.

Dr. Cartwbigut on Probing the Fallopian Tubes.

7=3

XI. PRACTICABILITY OF PROBING THE FALLOPIAN TUBES. IN

CERTAIN MORBID CONDITIONS OF THOSE ORGANS.

BY SAMUEL A. CART WRIGHT, M. D , OF NEW ORLEANS.

In Vol. 7, No. 6, page 804 of the New Orleans Medical and Surgical Jour-
nal, May, 1851, I published a case wherein I succeeded in catherizing the left
Fallopian tube of a large Ovarian Tumor. The patient had come from a long
distance to this city, and was resolutely determined to have the tumor cut out.
She was in constant torment from its pressure on the bladder. Her general
health was feeble, being pale and emaciated, and afflicted with bronchitis. The
tumor was irregular and knotty, yet seemed to contain a fluid. She said she
had perceived it from her earliest recollections, but it had not incommoded her
much until the two years since her marriage, during which time iodine, mer-
cury, and a variety of remedies had been tried, without effect. As mentioned
in the report of the case, Dr. Stone, on the 10th of March, 1850, was consulted,
and decided against an operation. About a week afterwards, finding that no
remedies would afford even temporary relief, I determined to try the practica-
bility of a new process — that of reaching the fluid in the tumor through the
Uterus and Fallopian tube of the side affected. I succeeded beyond my most
sanguine expectations in bringing away the greater portion of its contents ;
giving immediate relief without inflicting pain.

In the March number of the Charleston Medical Journal, (South Carolina)
a writer assuming the name of ".D. Warren Brickell, M. D., Natchez, Miss."
has seen proper to call in question the facts reported in regard to the case above
mentioned. I have made enquiry, and find that there is no Physician or other
person by that name in Natchez, or that ever dwelt in that city or its suburbs.
The writer in the Charleston Journal, by heading his article " Natchez, Miss.,'''
would lead the profession at a distance into the error of supposing that he is
a resident Physician of that place, and that my reputation for veracity is so
low, that a member of the faculty there can publicly assail it without injuring
his own. The question where the said writer resides, whether in Charleston,
New Orleans, or in some nook and corner in the country, is of no importance
to the profession, but simply whether he has any grounds for calling in ques-
tion the facts stated in my report of the ovarian dropsy case ? He casts some
doubt on the existence of such a case at all. He is quite sure that if there was
such a case, there was an error in the diagnosis ; that it was a uterine tumor
and not ovarian. He says this is the opinion of another practitioner, and he
thinks it is the opinion of nine out of ten ; and he winds up his article by think-
ing, that they " will soon begin to think that this operation [catheterism of the
Fallopian tubes] is really performed only on paper " I stated expressly in my
report that the tumor was ovarian, and that " the uterus was rather under the
usual size." The small size of the uterus is accounted for by another fact,
stated in my report, that a prolongation of the tumor had slipped down between
the bladder and uterus, compressing the latter organ. The tumor could not be

74 The New-Orleans Medical and Surgical Journal.

uterine, and my statement of the small size of the uterus be true. Whether
my report in regard to the diagnosis of the case be true or not, will appear from
the following certificate of Dr. Warren Stone, Professor of Surgery in the
University of Louisiana.

New Orleans, May 16th, 1852.
This is to certify that I was called by Dr. Cartwright on the 10th of March,
1850, to the * * * House, to consult in the case of Mrs. * * * who
Was laboring under an ovarian tumor, which I thought contained some fluid
and some irregular solid growths. Her general health was bad, and 1 thought
there were adhesions. I saw the same lady a few days since, and found
her general appearance that of fine health.

W. STONE, M. D.
This certificate settles the question of the existence of such a case, and whe-
ther it was an ovarian tumor or not. Additional evidence could add nothing to
its force. Stone, in New Orleans, is whatListon is in London, and what Phy-
sick was in Philadelphia. His testimony proves clearly that the writer in the
Charleston Medical Journal has committed an offence not only against me as
an individual, but more also against the medical profession and humanity itself.
Me, I have no fears of his injuring, where I am known, by the exercise of that
lowest and most puerile kind of criticism, consisting in mere contradiction
and denial of facts. But the denial of the facts, in this case, professing to
come from Natchez, where I so long resided, is an offence against the medical
faculty every where, as it is calculated to rob the profession of what little bene-
fit might be derived from the report of a case of a new and easy mode of reliev-
ing an intractable and fatal complaint. It is also an offence against humanity,
as tending to exclude the glimmer of light and hope, which this case would
bring to those who are similarly affected and are given over to suffering and to
death.

I Would not, however, be understood as wishing to make more out of Dr.
Stone's evidence than what is strictly due to it. I quote his evidence only to
prove, that such a case existed — -that my diagnosis was correct — that the tumor
was ovarian — that the patient's health was bad, when he first saw her upwards
of two years ago, and her appearance of fine health when he saw her a few
days ago. He was not present when the operation of probing the Fallopian
tube, to reach the tumor, was performed, and knew nothing about it. Nor
does any one through me, but her immediate friends. I would throw my repu-
tation to the dogs sooner than betray the confidence that the most humble wo-
man in the land has reposed in me as a Physician, and would suffer any tor-
tures sooner than drag before the public female witnesses in matters of this del-
icate nature. But in regard to the practicability of catheterizing the Fallopian
tubes, in certain pathological conditions of those organs, denied by the pre-
tended Natchez Doctor, I want no other evidence than that which is always
at the elbow of every well read Physician — Anatomy, Physiology and Pathol-
ogy. These are my witnesses, and with these I meet my accuser before the
tribunal he has arraigned me — the honorable Medical Profession^ Strong as
Dr. Stone's evidence has been against him on one part of the issue, these wil*

Dr. Cartwright on Probing the Fallopian Tubes.

be stronger still on the other. They will prove that the critic in this case is
about as little conversant wifh those sciences, as a certain anonymous critic
of one of my papers on Cholera was of Materia Medica, who wrote a caustic
philippic against what he mistook for an original mixture of mine, mercury with
chalk, without seeming to be aware that the Hydrargyrum cum Creta was an
officinal preparation of the Dispensatory, and that I was not responsible for the
chalk.*

It was stated in my report of the ovarian dropsy case, that I doubted the prac-
ticability of probing the Fallopian tubes in a healthy condition of those organs,
and suggested the possibility that it might be done during the catamenial pe-
riod. The writer,hailing from Natchez, calls in question the fact of my having
probed the Fallopian tubes, because he was unable to perform the operation on
the dead subject, and therefore would condemn me for having made a false re -
port. Jn doing so, he loses sight altogether of the important changes which dis-
ease is known to produce upon the human frame and its organs. I call upon
Pathological Anatomy to bear witness, whether or not disease works upon
those organs, called Fallopian tubes, sufficient changes to unable them to ad-
mit a probe ? It says, that there was a case, [very much like the one I re-
ported] recorded by Blancardi, of a patient who had suffered many years with
an ovarian tumor, and finally died. On dissection, one of the Fallopian tubes
was found to be enormously distended with serosity, and behind it was a cyst,
rilled with 10 lbs. of fluid. (See Diet. Science. Med. vol. 56, page 60.) The
question is, would that Fallopian tube, so enormously distended, have admitted
a probe ? The Speculum was not in use then, or the uterus could have been
reached, the cervix forced, the distended tube probed, the 10 lbs. cyst ruptured,
and the woman's life saved, as in the case I reported. Although our critic
must be aware of the existence of such an instrument as the Speculum, yet
he brings forward as a grave " obstacle" to the operation, " the distance from
the val va to the cavity of the uterus, and the length of the neck of this organ."
He thus counts the length of the neck twice, not seeming to be aware of the
difference that anatomists make between the cavity of the neck and that of the

* While the review of my Cholera essay was going through the press, I was writ-
ing some additional remarks on that complaint, then prevailing in New Orleans,
1849. I addressed a note to Dr . Hester, the editor, that if he and the author of the
Review had no objection, I would be glad to have a proof copy before the publica-
tion, as I wanted to receive as well as to communicate information. He sent me a
proof accordingly, and I have now in my possession a note from him, stating that
he had obtained the author's permission to do so. Nevertheless, this same anonymous
writer, after this, wrote and published another article, accusing me of having pur-
loined or got into the possession of said Review before its publication, by some disre-
putable, strange or unfair means. This is the first notice I have taken of it, as I had
the vanity to believe that nothing he could say or do could affect me where I am
known. Nor have I noticed, until now, the attacks on ;ne of the same anonymous
writer, in several numbers of the Charleston Medical Journal, believing that I have
friends in that city, who will, in the end, see that justice is done me.

76 The New-Orleans Medical and Surgical Journal.

uterus itself. All the great Accoucheurs, from Baudeloque backwards in the
last century and forwards in this, give instances of extra uterine pregnancy,
where the Fallopian tube has contained a foetus of nearly full size. Morgani,
Baillie, Good, Lisfranc, Tweedie, Watson, and almost every writer of note on
dropsical affections, treats of dropsy of the Fallopian tubes, and gives instances
of their enormous distention. The great Haller mentions a case, in which
the fluid measured 140 pints. According to Lisfranc's experience, dropsy of
the tube is more common than that of the ovary unconnected with a hygromic
state of the tube. Watson defines ovarian dropsy to consist " in the collection
of a fluid in one or more cells within the ovary, or in a serous cyst connected
with the uterine appendages." (The tubes, of course.) "Under all circum-
stances," says Watson, Lecture 47, " the malady is a serious one, for its griev-
ances are many, and its issue precarious and unpromising." After trying
every variety of medical treatment, the same author says, <k I must honestly
confess to you that I am unable to reckon one single instance of success." In
regard to excision he says, " the results of experience have been so dis-
couraging, as well nigh, in most minds, to prohibit such attempts in future."
Other methods, as that by puncture and injections, have not been attended
with much better success. The case reported by me, is the first on record of
the tumor having been reached per vias naturales.

The Fallopian tubes have been discovered, by recent observations, made by
Reid, Sharpey, Webber and others, to be engorged and distended with blood in
women who have died during the menstrual period. " Congestion," says
Churchill, " in the uterus and ovary, with certain changes in the Graafian ve-
sicles, occur at the menstrual period analogous, to a certain extent, to those
which take place after conception." The interior of the tube, in a healthy
state, contains a fluid-like mucus. The proper tissue of the tube has been lik-
ened, by anatomists from Haller down, to the spongy or erectile tissue. Its
inner surface is lined with mucous membrane in folds, the plica running longi-
tudinally. The celebrated Roux was the first to make the observation, that
the Fallopian canal is the only instance in the animal economy of an open way
to the cavity of the serous membranes from without ; and he supposed that
occasionally fluids, extravasated in the abdomen, found their way out through
this open channel. I am the first to turn that idea to practical account, by
breaking down the dissepiments in those tubes, when morbidly distended, to
reach a fluid contained within the upper portion of the tube and the cavity of
the peritoneum. Several Physicians, in London and elsewhere, have asserted
that they have probed the Fallopian tubes. But their object was to remove
obstruction^ to the ingress of the spermatozoa. Whereas I claim to be the
first who has probed them for the purpose of drawing off a dropsical fluid, and
succeeded in the attempt. If the cases were ever so limited, in which such an
operation would be practicable, the report of a successful operation would be of
too much importance for spite and envy to be permitted, without rebuke, to
discredit through the pages of the Charleston Medical Journal— a Journal,
which seems to be the organ of those, who would write me down, as it contains

Dr. Cart vvright on Probing the Fallopian Tubes'

lengthy and caustic reviews of some of my Essays, without publishing the Es-
says themselves, except only one short paper I intended for students of Compar-
ative Anatomy, yet headed with the same title as the principal Essay itself
under review in two numbers of the Journal, as if it were the matter reviewed,
and i had been heard, when I have not been.

After the ovarian dropsy patient had gone to parts unknown in a distant land,
and I could give no account of her, this next and last attack was made upon
me in the same Medical Journal. But the unexpected re-appearance of the
patient in New Orleans, in the hour of the supposed triumph, to stand before
Dr. Stone, and to be pronounced by him to be the same individual who had been
affected with the ovarian tumor, and in bad health, in March, 1850, and now, in
May, 1852, " has the appearance of fine health," is a severe rebuke to those,
if such there be, who prompted the attack on me professing to come from
Natchez, my old place of residence. There is no resident Physician there,
who either himself or as the organ of others, could have been induced to deny
my statements, and the practicability of probing the Fallopian tubes in certain
morbid conditions of those organs, or who does not know that in hydrops tu-
balis the tube is often sufficiently distended to admit the hand, if the uterus
was in a state to permit it to be reached.

Anatomy discloses the fact, that the tubes are composed of a structure cap-
able of great distention. Physiology, that they are associatedvery intimately
with the uterus and ovaries, and act in concert in health and disease. Patho-
logical Anatomy has demonstrated, that when the ovaries are engorged, so are
apt to be the Fallopian tubes, and that these organs partake in the changes
effected on the uterus by the molimen hemorrhagicum; Indeed, what is called
by Bennet peripheric inflammation of the uterus, is but another form of ex-
pressing the fact of the connexion existing between the lining membrane of
the cervix uteri and that of other uterine appendages. Inflammation of the
cervix is known to dilate the passage into the uterus to so great a degree as to
admit a finger. The same cause has a like effect in dilating the canal of the
Fallopian tubes.

I am moreover taken to task, in the Charleston Medical Journal, for having
incidentally mentioned, in my report of the ovarian dropsy case, that I had
cured some cases of dysmenorrhcea and sterility by probing the Fallopian
tubes. That a number of women, long afflicted with dysmenorrhea and ste-
rility, have got well and become mothers, I did not mention as anything won-
derful or peculiar to my practice ; as the same thing has often occurred in the
practice of others, whether they profess to treat such cases by catheterism or
not. The error consists in the gross darkness of the pretended Natchez Doc-
tor on the subject of uterine complaints, leading him to suppose that in the dis-
eased condition, the canals leading into the uterine cavity arc more constricted
than in the healthy state, and consequently more difficult to probe. Increased
sensibility of the parts, and not constriction, might make the operation difficult.
Leeching, bathing, steaming the uterus direct by an instrument for that pur-
pose; purgatives ; cold applications; camphor; anodynes, etc, are measures.

The New-Orleans Medical and Surgical Journal.

some one or more of which would remove exalted sensibility. So far, how-
ever, from the blood determined in increased quantities to the uterus and
its appendages constricting the calibre of its canals, the very opposite effect is
produced. This must of necessity be the case, from anatomical construction.
If this great law of uterine congestion did not obtain, a woman could never
have a child. The Fallopian tube would be too small to let the ovum pass
through it — the cavity of the organ too small to admit of its growth, and the
cervix too narrow to give it exit. Dr. J. Reid and others have demonstrated?
that the mucous membrane of the uterus possesses a tubular structure, which,
during the catamenia, as well as after conception, causes the glandular folli-
cles to become widened and enlarged. Thus thediscidua is formed, and it is
known that the ovum, in passing through the Fallopian tube, receives the
covering called the chorion, and that the disciduais formed whether the ovum
reaches the uterus or not. From the time of Morgani it has been known, that
in certain forms of dysmenorrhea the uterus, instead of secreting a fluid, forms
a membrane, or organized substance of a triangular shape, corresponding to
the shape of the uterine cavity. Unless the cervical canal were abnorminally
dilated, this membrane could not be extruded. The operation of Mcintosh
consists in dilating the cervix uteri to free it from the obstructing membrane.
That the lining surface of the Fallopian tubes should also secrete membrane,
when the uterine cavity does, is not improbable. The same pathological law
which causes the cavity of the neck of the uterus to expand and become easier
to probe, would likewise have a similar effect upon the canal of the Fallopian
tubes. Like the afferent and efferent lymphatic vessels, the causes enlarging
or contracting the one, must, as a general rule, have the same effect upon the
other.

But I have not time to pursue this subject further. My principal object be-
ing in this communication to protect, as far as I can, the little grains of seed
I have brought to the door of the storehouse of knowledge, from those who
would condemn and destroy them as unsound and worthless trash. And now
I request those editors who have published the remarks in the Charleston Med-
ical Journal of the pretended Natchez Doctor, calling in question the truth of
my report in the ovarian dropsy case, to publish this communication as an act
of justice to their readers. As to myself, I have no favors to ask. To perform
the duty I owe to science, without fear or favor, is the climax of my ambition.

New Orleans, May 22, 1852.

Note. — In this number a case is reported by Dr. Macgibbon, in which one of the
Fallopian tubes was greatly enlarged by disease ; thus tending to establish some of
the views enunciated in the foregoing paper.

{Ed. N. O Med. and Sur. Journal)

|)art 0mm&.

EXCERPTA.

FORENSIC MEDICINE.

L Infanticide by the Immersion of the Child in Pulverulent Substance*

Translated from the French of Adrien Beranguier, for the New-Orleans Medical
and Surgical Journal,

BY R. H. M.

There are few subjects in forensic medicine which present so many differ-
ent problems, as infanticide. Each repetition of the crime is attended with
new circumstances and contrivances not resorted to before. The circumstan-
ces of fact are infinitely diversified, and give rise to difficult and delicate
questions for the medical expert, whose business it is to interpret them. The
following is a case of infanticide, by means of which no mention is made in
our classical works on forensic medicine, and which, for this reason, seems to
me sufficiently interesting to be published.

On the 29th December, 1850, Martiane Combres was sentenced to hard la-
bor by the Court of Assizes at Tarn, upon the following state of facts, as char-
ged in the accusation against her.

About the end of the previous summer, this woman, aged 29 years, and a
widow for the last four years, ascertained that she was pregnant ; she con-
cealed her pregnancy, even from her mother, and on the 9th October she was
delivered in her chamber, and alone, of a male child. In order to get rid of
the child, she strangled it, or attempted to strangle it, and hid it in a grease
pot filled with ashes.

Was the child still-born when she deposited it in the ashes ? This was the
most important question of all others in the examination of the matter, and it

* The valuable contribution of M. Beranguier, in exposing a case of infan-
ticide which had not yet been foreseen in forensic medicine, supplies a real
hiatus in this department of medical practice. We earnestly invite to this
subject the attention of our confreres, whose position may furnish them with
analogous cases.

^0 The New-Orleans Medical and Surgical Journal.

was not without some difficulty and some hesitation that I decided it in the
affirmative.

Called upon immediately after the discovery of the crime, I wrote the follow-
ing report :

In the year 1850, on the 10th of October, at two o'clock in the afternoon, we
the undersigned, etc., on the requisition of the justice of the peace of our can-
ton, after having taken an oath before that magistrate, to make our report and
to give our opinion on our honor and conscience, proceeded with him into the
Departmentof Confonleux, for the purpose of there examiningthe woman Mar-
tiane Combres, widow Cols, who was supposed to have been recently delivered,
and to ascertain her condition, as well as that of a new-born child, which was
said to be concealed in her house.

I. Examination of the Mother.
On arriving at the house, we found, in a chamber on the ground floor, the
widow Cols dressed and lying on her bed. Our visit seemed to arouse her from
a drowsiness or stupor, real or feigned.

1 . Her face was pale and covered with the confluent freckles which are
peculiar to pregnant women, and which do not disappear until some days, or
even weeks, after confinement.

2. The pulse was small, concentrated and very frequent. Her countenance
expressed at the same time dejection and astonishment.

3. The breasts were a little tumefied, and slightly distended. On pressing
them gently towards the nipple, they yielded a few drops of a sero-lacteous
liquid, of a yellowish color, and of a nauseous odor.

4. The belly was flabby, wrinkled, and covered with stria, and whitish and
well-defined streaks on the side of the groins. There was also to be seen a
broad, brownish mark, more distinct below than above, extended from the me.
dian line from the pelvis to the navel.

5. On applying the hand to the hypogastrium, an ovoidal tumor was discov-
ered, which extended a little above the os pubis.

6. The external genital parts were slightly tumefied; the vulva a little open;
there was a discharge of reddish blood, not fetid ; the fourchette was flexible
and very depressible, not torn; the orifice of the neck was widely distended,
admitting two fingers easily ; the lips of the neck were short, soft, thick, infla-
ted, and, as it were, fringed.

7. We add, that this woman had had other children, and that the basin was
ample, well-formed, and adapted to an easy accouchement.

Conclusions. — From these seven observations we maintain —
1st. That the widow Cols had been delivered within twenty-four hours, at
farthest; winch is proven by the external condition of the breasts and of the
belly, by the character of the bloody discharge, and by an examination of the
genital parts, external and internal. (See arts. 3, 4, 5 and 6.)

Excerpla.

2d. That no other illness than an accouchement could have produced the
msemble, the series of circumstances which we observed.

3d. That the delivery must have been prompt and easy. (See art. 7.)

II. Examination of the Child.

After having examined the woman, the body of a male infant was presented
to us, which the justice and myself found covered with ashes, in a grease pot,
and which we discovered, from indications furnished by the accused herself, in
a small chamber contiguous to hers.

The body was immediately conveyed to the Mayoralty of Rabasteus, to the
Justice's office. There, after having washed it several times, to free it from
the ashes with which it was covered, and taking care not to immerse the mouth
in water, we observed :

1. That the child was large, fat, well formed, without fcetidness or any other
sign of putrefaction, and that there was a perfect proportion in size between
the lower and the upper members.

2. It weighed 2 kiliogrammes and 525 grammes. Its length was 50 centi-
metres ; 26 from the vertex to the navel, and 24 from the navel to the
soles.

3. The upper members were flexible and pale ; the lower members were ri.
gid, and exhibited some violaceous spots towards the inner surface of the
thighs.

4. The thorax was well arched, and very sonorous on percussion.

5. The sexual parts had acquired a complete development; the two testicles
were found in the scrotum.

6. The entire skin was thick, white and perfectly organized ; the nails of the
fingers and toes were well formed. On the head the hair was thick, black, and
a centimetre and a half in length.

7. There remained at the navel a very short piece of the umbilical cord, the
length of which was not quite two centimetres. The smooth and rectilineal
section demonstrated that it had been cut with some sharp instrument,
such as a pair of scissors, or a knife. I found no trace of a ligature.

8. The face, and all the skin of the cranium, especially on the left side, were
of a color very nearly approaching violet ; there was no tumor and no external
lesion apparent in this region.

9. On removing the skin, the bones of the cranium were found to be hard,
and resisting to pressure ; they were of a violaceous color, especially on the
left. This coloration, which was very decided on the outer surface, did not
extend to the entire thickness of the bone, and was not found on its inner sur-
face ; it seemed to exist only in the pericrani um. There was no trace of a frac-
ture, neither at the arch nor at the base of the cranium. The anterior fonta-
nel was not of the largest size, while the posterior was so small as to be scarcely
appreciable.

82 The New-Orleans Medical and Surgical Journal

1 0. The substance of the brain seemed to be healthy, but it was a little paler
than it is usually in new-born children.

11. From the fold of the chin to the sternum, and upon a surface having the
form of a trapezium, with the long side turned down, all the anterior portion of
the neck was very red and fretted, as if it had betn scraped with some sharp
instrument ; the skin, as if denuded of the epidermis, was of a red vermillion,
as if it had been scratched with the nails. Nevertheless, on incising it, we
found no subjacent lesion. Dissected with care, the fatty layer, the muscles,
and the thyroid gland exhibited no trace of ecchymosis. I did not find there
even the least drop of extravasated blood ; the larynx and the tracheal
exhibited no fracture ; their mucous membrane, slightly coated, was entirely
normal, as to its texture and color.

12. The mouth, the palate, the larynx, the nostrils, the neck of the windpipe,
the pharynx, and even to the entrance of the glottis, were covered with ashes*
They were also found in the entire upper third part of the oesophagus.

13. Proceeding next to open the stomach, we observed that under the bistoury
the muscles were red, with a beautiful flesh color ; a small drop of black blood
flowed from each little vein that was divided by the instrument.

14. In the thorax we found the organs well formed. The lungs seemed to
cover the entire pericardium ; they were rosy, and soft to the touch. We re-
moved them from the chest, with the heart and the thymus. After having
bound the tracheal and the larger vessels, we placed them in a large
bucket of river water, at 16 degrees of Reaumur, and they floated. Sunk to
the bottom of the vessel, these three organs rose promptly to the surface of the
water. The result was the same in spring water, at 12 degrees. Cut into
small pieces, the lungs crepitated under the bistoury. Each piece, pressed be-
tween the fingers under the water, rose rapidly to the surface.

15. After having removed the heart and the thymus, the lungs alone weighed
47 grammes. Their proportion to the weight of the whole body was :: 1 :
53.72.

16. The heart and the larger vessels contained black blood, but not in any
considerable quantity. On the inter-auricular wall we observed a sort of trans-
versal hiatus, capable of admitting a stylet ; this was the foramen ovale, which
was not yet obliterated.

17. It was only with difficulty that a very delicate stylet could follow the
passage of the vein and the arteries of the umbilical cord.

18. The viscera contained in the abdomen exhibited no morbid change, nor
any defect of conformation. The liver, of a reddish brown, and perfectly heal-
thy, weighed 1 19 grammes. The bladder was empty. The larger intestine
was filled with a deep green and very viscous meconium.

Conclusions.— From the facts detailed in this paragraph we considered it
established—

1st. That the child was born at the full period, capable of living, and of a

Excerpta.

good constitution ; which was demonstrated by the solidity of the bone
and the proportion in size between all the organs. (See arts. 1, 2, 4, 5, 6
and 18.)

2d. That it must have been born by the head, as was shown, as well by the
violaceous color of the skin of the cranium and of the pericranium, as by the
absence of any indication that it had come by the feet, or by the knees, or by
the breech. (Arts. 8 and 9.)

3d. That it was born alive, and that it breathed with full lungs for several
moments, and perhaps for several hours, as was demonstrated by the specific
lightness of the lungs. (Arts. 4, 14, and 15.)

4th. That it died a short time after its birth, as was indicated by the presence
of the meconium still retained in the larger intestine, and by the condition of
the vessels of the umbilical cord. (Arts 18 and 17.)

5th. That its death must have taken place within the preceding twenty.four
hours, since there was no sign of putrefaction.

6th. That although there were indications of strangulation at the anterior
part of the neck, and although ashes were found even at the entrance of the
glottis, the death was not produced by strangulation, or by asphyxia, because
the respiratory organs exhibited no change. (Arts. 11, 12 and 14.)

7th. That the death could not be attributed to hemorrhage through the um-
bilical cord, since the body and the viscera did not exhibit a bloodless appear-
ance (see art. 13); and yet, the paleness of the cerebral pulp, and the incon-
siderable quantity of blood found in the cavities of the heart and the larger
vessels, would have justified the admission that there was a great loss of blood
in consequence of the want of a ligature of the cord, and that this must have
weakened the child considerably.

Consequently, we are inclined to think that there may have been an attempt
at strangulation, that the hemorrhage through the cord may have compromised
the life of the child, but that it was still breathing when it was deposited in the
vessel filled with ashes.

It is not enough to be able to say to the magistrates, that the child came into
the world alive and capable of living ; the medical expert must also show the
manner of its death. In the present case, the infant had not lost a sufficiently
large quantity of blood through the umbilical cord to produce complete anemia ;
an attentive examination of the corpus delicti did not permit us to admit this
supposition ; moreover, some accoucheurs have contended that the omission of
the ligature of the cord is not always followed by a fatal hemorrhage. The
chafing and excoriations observed on the anterior part of the neck, which were
evidently produced during the life of the child, induced us to believe that there
had been strangulation, but the condition of the subjacent organs, the absence
of spumous matter in the trachea, the coloration of the lungs, &c, did not au-
thorize us to stop at this opinion.

The child was taken from a vessel rilled with ashes, and it was there that it
must have died, suffocated by the pulverulent molecules. There was no as-

84 The New-Orleans Medical and Surgical Journal.

phyxia, since the anatomical proofs of asphyxia were wanting on the opening
of the body ; but it was in the ashes that the infant drew its last breath. We
must adopt this latter supposition, because the ashes had descended very far
down into the oesophagus, and were stopped suddenly at the periphery of the
entrance of the glottis. This demonstrates that their introduction took place
during life, and that the epiglottis, by applying itself powerfully on the glottis,
prevented their entrance into the passages. If they penetrated there, it could
only have been after death, when all the organs were in a state of quiescence,
and by the shaking of the vessel filled with ashes.

The child, then, was placed in the vessel alive, and was afterwards covered
with the pulverulent matter. This was so, because science demonstrates it,
and because the confessions of the mother, after her condemnation, have con-
firmed, in every particular, the conclusions of the report.

There are other questions, purely scientific, which present themselves to the
medical expert, and it is the object of this memoir to give their solution,

1st. In a medium composed of pulverulent substances, is death instantane-
ous, or may life be prolonged for some time ?

2d. Under these circumstances, doe* the dust, such as ashes, flour, ground
plaster, etc., penetrate into the respiratory passages ? To what depth does it
enter into the digestive passages ?

3d. What are the anatomical characteristics presented by the lungs of a
newly born animal thus suffocated in pulverulent matter ?

These questions can only be solved by means of experiments.

Few sciences can be better illustrated by experiments on living animals than
forensic medicine. All the researches, so important, of our medical jurists,
testify to this fact, and are almost all based upon the experimental principle.
The chapter of infanticide, especially, presents a multitude of questions which
can only be solvea" experimentally.

This crime has been investigated under all its aspects. One page of Dever-
gie's* Forensic Medicine is devoted to an examination of all the means con-
trived by unnatural mothers who have endeavored to destroy their offspring.
There is not one who ever thought of suffocating the child in ashes. In the
annals of French forensic medicine it is a new crime, and hence the questions
which this mode of infanticide may give rise to, on the part of juries, or of
advocates, are unforeseen, and require that the expert should investigate all
the facts which may enable him to answer them plainly and categorically. A
short note inserted in the thirtieth volume of the Annates d* Hygiene Publique
et de Medecine Legale, informs us that Dr. Mattbysien, at Antwerp, had exper-
imented on rabbits and kittens, and of the manner in which these animals
died when they were buried in ashes.f But this note is so succinct and so in-
complete, that it leaves all the questions without solution, and it cannot be of
any assistance to us.

* Vol. 1, p. 614, first edition,
f Page 225.

Excerpta.

In order to determine the three questions which I have proposed, I commen-
ced by burying- in ashes four shepherd dogs, three hours after their birth ; they
lived fifteen hours in this pulverulent medium ; and at the autopsy, their lungs
seemed to me a little redder than they are in the normal state. The ashes had
penetrated even to the middle of the oesophagus ; the nostrils and the pharynx
were filled. Not an atom had entered the trachea ; they had stopped abruptly
all around the entrance of the glottis.

Before passing to other experiments, I took puppies of a large species, newly
born, and let some of them die in the open air, while others were drowned in
a pond of water. With the first, the lungs were slightly roseate, almost white;
with the others, they exhibited a coloration of a brownish red, very decided.
As to those which had been suffocated in the ashes, the lungs were of an inter-
mediate shade. The pulmonary parenchyma, without being of a reddish brown,
as in the subjects of asphyxia, was red enough to show that daring life the res-
piration must have been difficult and painful. Nevertheless, I did not find any
spumous matter in the larger bronchia?.

Comparative experiments were afterwards made with other substances re-
duced to dust, such as plaster and the fecula of wheat.

The ashes always penetrated farther into the oesophagus than the other pul-
verulent substances. Plaster and wheat flour form a paste with the mucosities
of the mouth and the pharynx, and adhere to the walls of those cavities, so that
the motions of deglutition cannot make them enter into the digestive channels
and conduct them into the stomach.

In the fecula of wheat, the animals lived seven hours less than in the other
pulverulent substances ; it seemed to become agglutinated on the epiglottis
and to impede its movements ; nevertheless, the puppies suffocated in wheat
flour did not exhibit, at their autopsy a pulmonary parenchyma of a deeper red
than those that died in the ashes or in the plaster.

With the dust taken from the highways, the effects were the same as those
produced by the plaster.

To sum up, our experiments have taught us —

1st. That the death of animals buried alive in pulverulent matter is not in-
stantaneous ; the air interposed between the molecules of the dust is sufficient
to prevent their dying by asphyxia.

2d. Where animals are buried alive in pulverulent substances, the dust re-
tained by the epiglottis, which applies itself convulsively on the glottis, never
penetrates into the larynx, and rarely enters into the oesophagus. I have never
found it in the stomach.

3d. The lungs of animals that have died in pulverulent substances, exhibit,
in the shades of red, an intermediate coloration between that which is peculiar
to the lungs of animals that have died in the open air, and that of those that
have died of asphyxia.

86 The New-Orleans Medical aud Surgical Journal.

II. — Of Flexion of the Limbs as a Means of Suspending and even Arresting
Arterial Hemorrhage.

As arterial hemorrhage is at all times more or less dangerous and alarming,
it becomes proper for us to notice all the means best calculated to put a stop tD
the flow of blood proceeding from divided vessels. To this end, we are pleased
to notice that Dr. Bobillier has turned his attention to this subject — the views
of whom we shall abridge from the February number for 1852 of the Journal
des Connaissances Medico- Chirurgical.

This gentleman has found, from experiment, that when certain arteries, situ-
ated about the joints of limbs, are wounded, the hemorrhage therefrom may
be arrested permanently, by flexing the limb forcibly upon itself. By this
means he arrested a hemorrhage from a wounded radial artery; and in ano.
ther case, the same means succeeded after compression,etc, had been fairly tried
and failed.

The third was the case of a man whose brachial artery was wounded by a
blow with a knife, just in the bend of the arm, at the usual point of venesection
— the hemorrhage was frightful, and the patient was so situated, and the acci-
dent was so unexpected, that the application of a ligature was utterly imprac-
ticable in the case. Violent and permanent flexion of the fore-arm upon the
arm arrested the bleeding.

Dr. Bobillier deprecates any desire to place flexion of a limb in competition
with the ligature, for arresting hemorrhage. He contends, however, that it is
a precious means, under certain circumstances — when the usual instruments
for the application of ligatures are not at hand.

In 1834 M. Malgaigne, in his Manuel de Medecine Operative, speaks favora-
bly of strong flexion of the fore-arm upon the arm, as a means of arresting
hemorrhage from wounds of the brachial artery. Four years thereafter, he men-
tions a case in which he arrested a hemorrhage from the popliteal artery, by
flexing the knees. (Ed.)

III. — Cyanuret of Potassium in large doses in Traumatic Tetanus — Efficacy of
Chloroform per anum et per os.

In the May No. for 1852, of U Union Medicate de la Louisiane, published in
this city, we learn that Dr. St. Martin succeeded in arresting the formidable
symptoms of tetanus by large doses of the cyanuret of potassium, aided by chlo-
roform given internally.

A lady of this city, aged about 35 years, was thrown from her carriage, and
her head struck against the curb-stone, causing a flesh-wound, which extended

Excerpta*

from the border of the scalp to the eyebrow. Notwithstanding the precautions
adopted by her medical attendant, on the 18th of February, five days after the
accident, unequivocal symptoms of tetanus were fully developed. The case
being determined, and the symptoms threatening, Dr. Martin ordered the follow-
ing portion :

The patient took of this half table spoonful every half an hour, at first, then
the same dose every hour.

The same medicine was continued, varying the dose according to the symp-
toms, up to the 4th of March, without any amelioration of the intensity of the
tetanic spasms. At this time Dr. St. Martin suspended the Cyanuretof Potas-
sium, and substituted Chloroform in 20 and 30 drop doses, both by mouth and
rectum. Under the latter treatment, the author of the report tells us, the symp-
toms of rigidity were perceptibly diminished, and by continuing this treatment,
the patient by the 14th of March was fully convalescent. The patient, during
the 16 days' illness, took 186 grains of the Cyanuret of Potassium; but we
are unable to discover from a perusal of the case, that any material benefit was
derived from its use ; no improvement was manifested until the Chloroform
was substituted for the Potassium. We are rather disposed to give the credit
of the cure to the judicious regimen adopted by the Physician, and to the lapse
of time — it being well understood that this formidable disease is but little influ-
enced by the most enlightened medication, and it usually exhausts itself or the
patient in fifteen or twenty days. (Ed.)

VI. — The Cause and Prevention of Death from Chloroform.

Dr. Snow said that when dogs, cats, or rabbits were made to breathe air
containing from three to five per cent of vapor of chloroform till they died—
a process which occupied generally from ten to fifteen minutes — the heart con-
tinued to act for a minute or so after the breathing had ceased, as he had ascer-
tained by means of the stethescope, and then, in some instances, the animal
gave a few gasping inspirations about the time when the heart was ceasing to
act, which had the effect of restoring it to life. On the other hand, when such
animals were made to breathe air containing eight per cent or more of the va-
por, death took place very suddenly, the respiration and the heart's action
ceasing together. He had indeed performed three experiments in which the
action of the heart stopped before the breathing. Jn experiments with sul-
phuric ether, the action of the heart always survived the respiration, as air con-
taining fifty per cent of ether vapor was not more powerful than when it con-
tained but five per cent of vapor of chloroform. Ether could, however, be
made to act directly on the heart, by continuing to exhibit it by artificial respi-
tion after the natural breathing ceased.

He believed that no accident had occurred from the continued exhibition of
chloroform vapor, well diluted with air. In the fatal cases which had happened,

Gum-water,
Cyanuret of Potass.

f 5iv
gr. vi

88 The New-Orleans Medical and Surgical Journal.

death had taken place suddenly, by the way of syncope, showing that the heart
had been paralysed by the action of vapor constituting not less than eight or
ten per cent of the air inspired just before death. He enumerated all the
deaths which he considered to have been caused by the administration of chlo-
roform. They were eighteen in number. In sixteen of these, the agent was
exhibited on a handkerchief, or towel, or piece of lint, and in the two cases in
which some form of inhaler was employed, it was not used by a medical man.
The subjects of these accidents had enjoyed a greater amount of general
health than the average of those who had taken chloroform ; none of them
were children or old people, and the operations which were intended or had
been commenced, were, with two or three exceptions, of a trifling nature. He
considered the reason of this to be, that under such circumstances the same
amount of care was not always employed as in more serious cases. There
were two methods of ensuring the dilution of vapor of chloroform with at-
mospheric air, to such an extent that death could not occur without giving
sufficient warning to allow of accidents being prevented by ordinary atten-
tion and skill.

The first and best of these methods was, to exhibit pure chloroform by means
of a suitable inhaler ; the other method was, to dilute the chloroform with
rectified spirit of wine, before pouring it on a handkerchief or sponge. One
part, by measure, of chloroform, to two of spirit, which constituted the strong
chloric ether of Dr. Warren, of America, answered very well; but he (Dr.
Snow) gave the preference to equal parts, by measure, of chloroform and spirit,
which he was in the habit of applying by means of a sponge, in operations on
the face, when he could not employ the inhaler. The best means to be em-
ployed in case of impending death from chloroform, was artificial respiration.
He believed, from experiments he had performed on animals, that if it were in-
stituted within half a minute of the apparent death of the patient, it would, in
the greater number of cases, be attended with success. If this measure did
not very quickly restore the patient, it would be advisable to open the external
jugular vein, wmilst still continuing the artificial breathing, in order to relieve
the distension of the right cavities of the heart, which in these cases begins to
take place as soon as its action ceases.

Dr. Crisp had found that twenty cases of death from chloroform had been
published. He had placed them in a tabular form, and enumerated them to the
Society. His opinion respecting chloroform, deduced from those cases and his
own observation was, that we could not employ it, even to healthy individuals,
without some amount of danger. He differed from Dr. Snow in his opinion
regarding the impossibility of robberies being effected by the agency of chlo-
roform, as it might easily be applied to half inebriated persons. An important
question was, what are the ultimate effects of chloroform on those who take it
in surgical operations ? This, he contended, could only be answered by 15,000
or 20,000 cases.

Dr. Theophilus Thompson inquired the experience of Dr. Snow respecting
the effects of chloroform on the system in certain cases in which the change
effected was often durable or important ; in fact, a train of symptoms indicat-
ing more or less congestion of the brain, and lasting for many days, or even
longer.

Mr. Bullock said that the effects of chloroform were materially modified by
its purity ; much impure chloroform was manufactured. He had seen it ad-
ministered to a patient, who was three hours under its influence, without any
bad effects.

Mr. Richardson believed that cases of death from chloroform had occurred
which had not been alluded to by Dr. Snow, and he mentioned one in particu-
lar which had taken place in Bruges. In deaths from chloroform in animals,

Excerpia.

he found the right side of the heart congested, and left auricle contracted ; for
thirty-five minutes after death in one case — the peristaltic action of the bowels
also continued after death.

Dr. Camps considered that the influence of idiosyncracy should not be over-
looked in estimating the effects of chloroform in particular instances. He
believed that the first effects of chloroform were principally on the nervous
system.

Mr. Barlow thought that the danger of administering chloroform by sprink-
ling it on a handkerchief, had been overrated. If there were not too much
chloroform used, if the handkerchief were not placed too near, and there were
not too many bystanders, and the patient were properly watched, he saw no
reason to fear the administration of chloroform without an instrument. Pro-
per note of the effects of chloroform during its administration was most essen-
tial. One person should always be watching for these effects. He had never
seen a patient in danger, so long as the iris remained contracted; but if the
iris dilated, the inspiration became difficult and the pulse flagged, the chloro-
form should be immediately discontinued. The deaths in some cases, he be-
lieved, had arisen from the desire, on the part of the operator, to administer the
agent too rapidly. When death occurred, he believed it was from the heart
becoming suddenly affected. The history of cases, however, in which the use
of chloroform had been attended with a fatal result, had not, in some cases,
been sufficiently stated for us to form a correct opinion upon them ; often the
previous condition of the patient was not mentioned. In some of the cases
better recorded, a defective condition of the structure of the heart was present.
What should we do in a case of poisoning by chloroform ? We should employ
all the means recommended by Dr. Snow, and more especially resort to artifi-
cial respiration early.

Dr. Sibson said, that owing to the researches of Dr. Snow, we were now in
a condition to determine the exact quantity of chloroform which was admitted
into the system. He believed that in cases of death from chloroform, it was
the heart that was at fault ; the symptoms presenting themselves, such as sud-
den pallor, etc., showed this to be the case. He did not agree with Mr. Bar-
low, that it was necessary to stop the chloroform when the iris contracted, as
in some cases, as of dislocation and hernia, it was necessary to carry the use of
the agent beyond this point, which might be done with safety under proper pre-
cautions. With respect to the use of chloroform in neuralgia, it was not ne-
cessary to carry it to the extent of unconsciousness ; anaesthesia was produced
before this. With respect to the number of deaths which had occurred from
the use of chloroform, he thought this was little, in comparison with the num-
ber of persons who had been relieved by its use.

Mr. C. Clark inquired the experience of members in respect to the employ-
ment of chloroform in midwifery.

Dr. Murphy advocated its use in midwifery in suitable cases, and with proper
precautions. Deaths from chloroform were usually the result of carelessness
in its administration — deaths resulting from the employment of too concentra-
ted a dose, which acted suddenly upon the heart.

Dr. Chowne spoke at some length on the importance of the subject, and the
circumspection which was necessary to be observed in the employment of chlo-
reform. With respect to its use in midwifery, he thought many disasters had
resulted from it, not only as referred to immediate, but to after consequences.
Many cases had occurred which had not been published. He cautioned the
members respecting the employment of chloroform, to which he was no
enemy, but he was desirous to see its use accompanied with the greatest
caution.

90 The New-Orleans Medical and Surgical Journal,

Dr. Snow said in reply, that the difference between the number of the deaths
from chloroform in the list he had given, and in other lists,arose chiefly from the
circumstance that he had excluded some deaths which had been attributed to
this agent, but were due, in his opinion, to other causes. The case of the child
mentioned by Dr. Crisp, for instance, occurred in Germany, during the excision
of a very large naevus on the side of the face and neck, which surgeons, who
had seen the case previously, were afraid to meddle with. The operation lasted
eighteen minutes, only nine drops of chloroform were applied altogether, and
none at all during the last eight minutes. Death was evidently due to syncope
from the effects of the operation. As regarded the cases in which daath hap-
pened during a second attempt to render the patient insensible by chloroform,
they could not be attributed to the cumulative effects of the vapor which had
been inhaled during the first process; for chloroform could not accumulate for
more than twenty or thirty seconds ; after this time it began to be exhaled again.
These cases clearly illustrated the uncertainty and irregularity of the means
which had been employed in administering the chloroform, and showed that
the accidents were not due to any peculiar susceptibility to its effects on the part
of the patient, who could not have two different idiosyncrasies nearly at the
same time ; first, a want of susceptibility, and a few minutes or half an hour
afterwards, a greater susceptibility than usual.

In reply to Dr. Theophilus Thompson, Dr. Snow stated, that he had not met
with any unpleasant sequelae which he considered to be the effects of chloro-
form, except sickness, which had in a few cases been troublesome for two or
three days, and hysteria, the latter of which might certainly occur from an
operation without chloroform. If depression existed from the long-continued
administration of chloroform, it should be removed by warmth and cordials.

(London Lancet.)

V. — On the treatment of Cancer by the Lactate of Iron} taken by the mouth and
injected into the veins.

BY DANIEL BRAINARD, M. D.

About two years since I communicated to Prof. Mussey, chairman of the
Committee on Surgery of the American Medical Association, some reasons
which I had for supposing that the lactate of iron was possessed of more influ-
ence over cancer than any medicine yet known.

1 have, since that time, had occasion to prescribe it often, with results
which, while they confirm the views expressed in regard to its efficiency in
checking it, have not shown that it was capable of entirely curing it. This
result was to me neither surprising nor discouraging, as I have already formed
and expressed the opinion, that to effect a cure, " the whole of the solids
and fluids of the body must be brought under its influence." That this is
not effected by the simple introduction of medicines into the stomach, is suffi-
ciently obvious, and indeed to be expected, since the medicine, used in that
way, is subjected to the action of the same nutrition and absorption under the
influence of which the disease has originated. It is necessary to go behind
this ; and one of the means of doing so is by injecting it into the veins. It is
only recently that I have had an opportunity of putting this method to the test
of practice.

Case. Dec. 13, 1852. W. H. Plumb, aet. 56 years, Englishman, applied to
me on account of a tumor of the left orbit.

Excerpla.

He gave the following history of his disease :

" About twenty-five years ago he had a disease of that eye, called by hi*
Physician cataract, which entirely destroyed the vision, but for which no ope-
ration was performed. About five years ago he received an injury of that eye,
from a stick striking against it, which was slight, and gave but little pain.
About seven months after this blow, he noticed a tumor, no larger than a pea,
at the inner canthus, "sending off roots into the eyeball." At this time the
tumor and eyeball were removed together by Prof. Smith of Baltimore. The
wound cicatrized well.

He remained in pretty good health about four years, when a tumor made
its appearance at the lower and inner part of the orbit, which in eight m onths
attained the size of a large hickory nut. It was then operated upon again,
but at the end of about six weeks recommenced to grow, and at the time of
this examination, was of the size of an orange, filling up the whole of the
orbit, and projecting in front of it. Its surface was nodulated, elastic, pulsat-
ing, ulcerated to a great extent, and from this point there oozed a bloody se-
rous fluid. He was thin, but not sallow, and his health was not very much
impaired. He complained, however, of acute lancinating pains through the
orbit and head.

16th. Extirpation was performed in presence of the hospital class. It was
found so firmly attached to the lower part of the orbit, that it wTas necessary to
remove the periosteum with it, and at the back part it could not all be removed.
There remained a muscular mass, which bled profusely, and which was so soft
as to break under the forceps or tenaculum. After several ineffectual attempts
to apply a ligature, the actual cautery was resorted to and succeeded. The
wound was dressed with lint. No inflammation followed. There was a copi-
ous discharge of red serum for a day or two, which gradually became yellow,
and afterwards changed to pus. He was put, from the day of the operation,
on the use of lactate of iron gr. v, three times a day in solution.

31st. Injected into his veins f 3 j of the following solution :

Jan. 3, 1852. Injected 3 ij of the same solution.

6th. f 3 iij thrown in.

14th. 3 ijss injected.

22d. 3 ij'.

26th. 3 ij.

28th. 3 ij.

Feb. 3d. 3 ij injected. 9th. 3 ijss.

During the whole of this time the wound cicatrized rapidly. At first luxu-
riant granulations sprang from the surface, which were repressed by the appli-
cation of nit. silver. Lancinating pains continued for some time, but gradually
diminished, and at length subsided.

In six weeks from the operation the cicatrization was nearly complete. In
eight weeks he returned home perfectly well.

The question, whether the diseased mass was a cancer. I do not hesitate to
decide in the affirmative. Its history and appearance sufficiently indicate this;
its interior perfectly resembled the brain of an infant in a vascular state, and
under the microscope it exhibited the most perfectly formed cancer cells. Dr.
Johnson, resident physician, fully coincided in this point.

Whether it would have cicatrized without the use of the lactate of iron, can-
not be determined with the same degree of certainty. Taking into considera-
tion the return, when last extirpated, with the fact that it was afterwards im-

Ferri lactis,
Aq. dist.

gr. vi ij

The New-Orleans Medical and Surgical Journal.

possible to remove the whole of it, I think the probability of obtaining cica-
trization by ordinary means was slight. I should not, however, have thought
of performing, or attempting extirpation, but that the patient, who is intelligent
and trusting, expressed his desire to be submitted to the treatment, when it
was explained to him.

I am aware that many surgeons, under the influence of preconceived opin-
ions, may regard such treatment as hazardous. I had fully convinced myself
that such was not the case. I have repeatedly thrown gr. x lactate of iron, im-
perfectly dissolved in an ounce of water, into the veins of a small dog, without
producing in any case peculiarly bad results.

It will be seen that gr. iij was the largest quantity thrown in at a single time.
It was passed in gradually and cold, and as soon as sensible effects were pro-
duced, it was stopped. The effect noticed was a flush of the face, a fulness of
the veins of the head, and a tendency to sneeze, which all passed over in a few
seconds. The circulation otherwise was unaffected. If the case had not pro-
gressed favorably, and it had seemed advisable to change the nutrition more
profoundly, I would have had the solution warmed and put it in slowly until its
effects were perceptible; then allowing it to pass over, have repeated it as far
as appeared safe.

Up to the time of his departure, the injection had been performed nine times,
and grs. xix in the aggregate injected. When the activity of the salt is con-
sidered, it will be conceded that such a quantity is capable of having an effect
on the system, by being thrown into the blood.

In addition to that, he has during this period of eight weeks, taken 3 xix of
the lactate by the mouth ; to what extent this may have been absorbed and car-
ried into the circulation, or what changes it may have undergone, it is impos-
sible to determine.

In case of a cancerous disease seated upon an extremity, I should, in addition
to the two methods of administration resorted to in this instance, infiltrate the
whole of the diseased and the healthy tissue about it with a weak solution of
the medicine. This can readily be effected by putting a ligature, moderately
tight, about the member, until it becomes oedematous, when, by the aid of fric-
tions, the infiltration and maceration may be effected.

I had omitted to mention, that all the injections were made into the veins at
the elbow.

In submitting this case to the profession, I am far from claiming for it any
merit which it does not possess, or drawing inferences which no single case
could warrant. It is offered as an evidence of the practicability and safety of
maceration through the medium of the blood, systematically pursued with ac-
tive substances, and to invite attention to other means of treating this invete-
rate disease than those which hitherto have been admitted by consent to be
unsuccessful.

Chicago, February 21,1 852.

{American Journal of Medical Sciences.)

Excerpt a.

VI. — Explanation of the Function of Respiration in Mare,

BY PROF. DRAPER.

The April No. of the American Journal contains a very valuable paper on
" Respiration ," by Dr. Draper, in which he sums up his views on the subject
in the following' words, viz : (Ed.)

The air introduced by atmospheric pressure, brought into play by the action
of the diaphragm and other respiratory muscles, fills, in ordinary respiration,
the nasal passages, trachea, and larger ramifications of the bronchial tubes.
Between it and the gas coming from the pulmonary vesicles, diffusion steadily
takes place, tending to remove the cell-gas into the atmosphere; but this gas
is not brought from the vesicles by diffusion, which could not act with sufficient
speed, but by the contraction of the circular organic muscles of the bronchial
tubelets and of the cells, the different bronchial trees not acting simultane-
ously, but successively. As soon as the contraction is over, the tubes expand
by their elasticity, and" air is drawn into the cells. It is probable that in "pro-
ducing these results, the vibrata cilia conspire, and the effect is aided by the
contemporaneous contraction of other bronchial trees, and the whole process
ends with the expulsion of the foul air. which has accumulated in the lamer
bronchi and trachea, by the diminution which ensues in the general capacity
of the chest during expiration. In respiration the lungs are not, therefore,
passive, as is commonly said.

The exchange between the gas in the cells and that in the blood, does not
occur through simple diffusion, or in quantities proportional to the diffusive
volumes of the oxygen and carbonic acid. It is a complex diffusion, in which
the disturbances arise from the gases in the blood being either dissolved or
combined ; and through three intervening membranes, that of the air-cells, of
the pulmonary capillary, and of the blood-disk, all of which exert a condensing
action, of the result of which it is impossible to furnish any numerical es-
timate.

Brought into presence of the haematin, the oxygen may possibly associate
itself therewith, in a manner analogous to that which we witness under simi-
lar circumstances with deoxidized indigo.

In thus attempting to correct the account ordinarily given of the function of
respiration, the only original points I present are :

1st. The necessity of admitting the constant action of the circular organic
muscles.

2d. The condensing action of the three tissues, the wall of the pulmonary
vesicles, of the pulmonary capillary, and of the blood disk.

3d. The probable analogy between the relation of ha^matine and another
nitrogenized coloring principle, indigo.

VII — Quinine in Urticaria.

BY DR. WICKHAM,

Dr. Wickham has found in the wards of M. Legroux several cases of urti-
caria, complicated with severe pains in the joints, yield readily to quinine ; a
remedy, he observes, also useful in simple urticaria, which exhibits the same
fugacious characters as rhumatism. It is from its analogy to neuralgia that
M. Cazenave has recommended arsenic in urticaria.

The New-Orleans Medical and Surgical Journal.

VIII. — On the Suspension of Gum-Resins.

BY M. POULENC.

In this paper M. Poulenc describes the mode he successfully adopts of sus-
pending gum-resins, as assafcetida, ammoniacum, myrrh, etc., in mixtures of
enemata. If the division of the body be accompanied by means of yolk of egg,
it is a very tedius process ; but if to every gramme of the gum-resin we add
six or eight drops of sweet almond oil, it easily becomes broken up. When
the oil has become well incorporated with the mass, and a homogeneous paste
is produced, the vehicle is to be added, at first gradually, and then entirely. A
complete emulsion is thus produced in a very short time. Another advantage
of this mode of preparation is, that it allows the mixture to be warmed, if
required, before employing it, without causing any coagulation. M. Poulenc
employs the same means of subdividing the gum-resins which enter into the
composition of emplastra.

(Bull, de Therap., vol. xli.)

IX. — Traumatic Lesion of the Lung — Division of Intercostal Artery.

During the troubles of February, 1848, a young man aged 18 years was
wounded with the point of a bayonet, which penetrated to the depth of ten
centimetres the tissue of the lungs, between the second and third rib. Blood
nWed freely, and the patient's strength was nearly exhausted, when M. Lalibu-
rac arrived near him. His skin was cold, and pulse only 55. The medical
attendant, from the bright color of the blood, suspected a wound of the inter-
costal artery. He immediately introduced into the wound the end of his little
finger, and pressed it forward for three quarters of an hour against the inferior
border of the rib, when the hemorrhage ceased, and the wound was dressed
without farther delay.

The pulmonary inflammation which followed was subdued by leeches,
blisters, etc. The patient recovered.

(Gazette Med. de Paris.)

X. — Mode of Administering Balsam of Copaiva.

BY M. CHERVET.

Thirty parts of the balsam are stirred round in a glass mortar with four of
sulphuric acid. The mass quickly solidifies, and maybe made into pills,which
may be afterwards covered with a coating of gum and sugar. If the copaiba be
adulterated with castor oil, the solidification does not take plane; while, if
adulterated with turpentine, although solidification does take place, the mass,
when placed in water, becomes covered with a white, bitter, resinous substance.
The medicinal virtues of the copaiva are by no means impaired by the above
proceeding, while its disagreeable flavor is destroyed.

(Jour, de Chemie Med. 185].)

Excerpta.

XL — Minute doses of Morphine in (he treatment of Typhoid Fever.

The May No. for 1852 of the New York Medical Journal contains an in-
structive paper on the treatment of Typhus Fever, by Dr. Bennett of Connec-
ticut.

Dr. B. tells us he treated 30 cases of well marked Typhus without losing a
single one. His practice is certainly original and peculiar to himself. Like
Dr. Henry of Illinois, who gave 4 and 5 grain doses of opium in acute attacks
of Dysentery, and with signal success, Dr. Bennett seems destined to put forth
a plan of treatment equally at variance with the preconceived opinions of the
profession.

Dr. Bennett shall speak on this subject for himself. He says : Ed.

This method consists simply in the continued repetition of minute doses of
morphine in solution, at intervals of one, two, three or four hours, according
to the circumstances of the case. I dissolve one grain of the sulphate of mor-
phine in 4 or b' ounces of water, according to the age of the subject and the
intensity of the symptoms, and commence by giving the patient a teaspoonful
of this solution every two hours. In the first stage of the disease, when there
is much pain in the head and limbs, jactitation, wakefulness, etc., the repetition
of this dose for 24 or 48 hours, has almost uniformly succeeded in controlling
these symptoms, and they have given way to a degree of quiet, highly refresh-
ing to the patient. The steady exhibition of the medicine in this manner soon
produces a tendency to protracted sleep, and it may be necessary to abate the
frequency of the dose, giving it every third or fourth hour only. After some
days continuation of this treatment, it has been common to see the heat and
dryness of the skin give way to a general perspiration, more or less profuse,
and affording much relief to the patient. This has occurred a number of times
during the course ot the disease, in some cases the first alleviation of the symp-
toms being followed by an exacerbation, which again yielded to the same favor-
able conditions. In other instances, the disease has seemed to yield its sever-
ity almost to the first decided impression made by the exhibition of the medi-
cine. The following case, condensed from my notes, was most striking in this
respect.

We omit his cases ; but they certainly bear unmistakable proofs of genuine-
Typhus.

He concludes his paper as follows :

The duration of the thirty cases treated in this manner has varied from 16 to
45 days, and the degree of the gravity of the symptoms has been very different
in individual cases, although in the aggregate there has been considerable uni-
formity. In those cases which were protracted to four, five and six weeks, and
in which delirium was a common symptom, 1 continued the treatment up to
the period of commencing convalescence, and did not in a single instance ob-
serve any untoward symptoms which could be attributed to the protracted ad-
ministration of the medicine. In no case have I seen any signs of that pecu-
liar nausea which often follows upon the exhibition of opium in the ordinary
manner, and I have attributed this exemption from so unpleasant a consequence,
not only to the minuteness of the dose, but also to the degree of dilution to
which I submit the morphine.

The only adjuvants to this treatment which I have er^oloyed, have been the
occasional exhibition of a few grains of Dover's powder and calomel at night,
in the earlier stages of the disease, before the morphine had produced a deci-

98 The New-Orleans Medical and Surgical Journal.

ded effect, together with now and then a laxative dose, as circumstances re-
quired at any stage of the disease.

Whethor future trials of this simple method of treating typhoid fever will
justify me in adopting it exclusively, is yet to be determined ; but its apparent
success thus far, Ithink, fully warrants me in giving it a further trial.

Quere? Did these 30 cases recover maigre le trailmenl ? C'est possible !

(Ed. N. O. Med. Jour.)

XII. — Effects of Morphine in Hernia.

BY EDWARD W. DOMAN.

[Mr. Doman relates a case in which a laborer, a native of Suffolk, aged 32,
had been the subject of left inguinal hernia for five years. It had frequently
come down, but always returned on assuming the recumbent position. On the
18th he was attacked with severe purgings ; and on the 19th the hernia des-
cended, but was soon returned ; but in the afternoon it again descended, and
could not be returned. On the 20th he was taken home, and at 5 P. M. Mr.
Doman was sent for. He found a direct inguinal hernia of the left side, of con-
siderable size, and filling the scrotum of that side; tense and painful; he had
vomited several times, and complained of much pain below the umbilicus. As
he was considerably prostrated he was not bled, but placed in a warm bath and
the taxis applied. Mr. Doman continues :]

After persevering with the taxis for some time, without avail, I had him put
to bed, and gave him half a grain of muriate of morphine every hour, until he
had taken one grain and a half. He was soon considered narcotized ; vomit-
ing had ceased and pain moderated. I again tried the taxis, without effect.
Thinking that he would become still more under the influence of morphine,
I left him for a short time. The taxis was again tried, but as before, without
effect.

About 8 A. M. of the 2 1st, he had recovered from the effects of morphine;
the hernia, as tense and as large as at first, and having been in that state up-
wards of 36 hours, I told him that I thought it would be necessary to operate, but
I would first try a warm bath and bleeding. I bled him in the bath ad deliquium,
and attempted reduction, but failed ; he was now put to bed, where he became
sick, very faint, and covered with protuse perspiration. I again tried to reduce
it, but without any effect on the hernia. On his recovery from syncope, I told
him it would not be safe to delay operating any longer. It was now ten A. M.
He positively refused to allow the operation. He was again in great pain, par-
ticularly on handling. I thought if I brought him more completely under the
influence of morphine, there might be a chance; and as he still refused to be
operated on, I began giving him half grains of morphine every hour, until he
had taken two grains and a half. About 3 P. M. he was quite narcotized, and
on examining the scrotum I found it more flaccid ; and on using the taxis, the
hernia in a few moments passed up easily; he was immediately relieved, after
having been 48 hours in suffering. He slept quietly that night, kept himself
quiet all the Friday, his bowels acting that day without medicine; and after
fitting himself with a truss, which he had never yet worn, he returned to his
work on Monday, the 25th.

(London Lancet, 1851.)

part ®I)iriL

REVIEWS AND NOTICES OF NEW WORKS,

I. — An Address to the Graduates of the Medical Department of the St.
Louis University, Session 1851-2. By Charles A. Pope, M. D.,
Professor of Surgery.

On the Claims of Priority in the Exsection and Disarticulation of the
Lower Jaw; containing the Report of several Operations performed.
By Geo. C. Blackman, M. D., Fellow of the Royal Medical and
Chirurgical Society of London.

Valedictory Address to the Graduating Class of the Medical College
of the State of South Carolina. By E. Geddxngs, M. D., Professor
of Surgery.

A History of the Art of Midwifery : A Lecture delivered at the Col-
lege of Physicians and Surgeons. By Augustus K. Gardner, Fel-
low of the New York Academy of Medicine, dec.

The Organizing of the American Medical Association : An Address
read before the Philadelphia County Medical. Society, February,
1852. By the President, Samuel Jackson, M. D., formerly of
Northumberland.

Thirteenth Annual Report of the Directors and Superintendent of the
Ohio Lunatic Asylum to the Assembly oj the State of Ohio. For the
year IS 51.

So many pamphlets are spread before us, embracing such a discur-
sive range in medical literature and scientific disquisition, that the
tastes of ail readers may be satisfied — even to full saturation, save those
whose caprice is boundless, and who know no satiety, even in stepping
"from the sublime to the ridiculous."

To begin at the beginning — we shall not greatly err if we assign to

98 The New-Orleans Medical and Surgical Journal.

the address of Professor Pope the first corner in the vocabulary, in
which he has sought, in an earnest, forcible and instructive manner,
to rescue the Science of Medicine from the obloquy which some persons
have sought to cast upon it, because its ablest advocates have not been
able to claim for it infallibility, any more than have the expounders of
Divinity and of Law failed to assert that of the former, were many
things difficult to be understood ; and in the disputation of the latter»
that a " glorious uncertainty not unfrequently prevails."

To a passionate fondness of his profession, Professor Pope has super-
added untiring industry and no ordinary zeal ; the importance of these
qualities is strenuously urged upon those whom he addresses.

The style of the author's writing is free from that grandiloquence so
peculiar to some men, and who, in straining for effect, produce no other
than that of astonishment, which quickly subsides into disgust ; and
who, in giving us a train of their ideas, would often be intelligible were
they within the scope of mortal comprehension.

The author, also, in carrying out the position to which we have re-
ferred, has neither labored too much nor too long, a " consummation''
which, however " devoutly to be wished," does not fall to the lot of
all with whom we have an inkling of acquaintanceship through that
mighty instrument — the pen !

There is a moral sentiment pervading the address which speaks well
for the amenity of the heart.

In claiming that Theology and Medicine are based upon principles
which shadow forth correct rules of action, Professor Pope uses the
following language :

" In Theology, too, we may observe discrepancies, which no more affect the
truth of religion, than do those of Physicians disprove the certainty of Medicine.
There is but one true faith, as there ia but one true science ; and as many dif-
ferent sects in the one do not militate against the truth of religion, neither do
the different by-systems followed by charlatans afford any argument against
medicine. I would not pronounce any creed founded on the Bible entirely
false ; nor would I say that there are not a few grains of truth to be found in
every false system of medicine ; but would rather note the contrast which
exists between the genuine and the false. As the barbVism and idolatry, the
error and the superstition of Paganism, Mohammedanism or Mormonism, but
serve the better to exhibit and enhance the simple beauty and sublime truth
of Christianity, so the dignified and solid truth of Medicine are only the more
apparent, when contrasted with the flimsy and groundless pretensions of Empy-
ricism, whether in the shape of Thompsonianism, Electro-Thermalism, Hydro-
pathy, or last, but not least; Homoeopathy — that double distilled essence of hum-
bug and quackery."

Reviews. — Addresses, Reports, etc.

We now turn from the pages of Professor Pope, feeling assured that
those to whom " the proper study of mankind is man," may not have
employed their time amiss whilst perusing them.

In urging upon the Medical Profession a new organization of the
American Medical Association, Dr. Jackson does so chiefly upon the
ground that the present organization is anti-republican, the Association
embracing but comparatively few members (the total number being
about 900), although five years have now elapsed since its organization;
it is sought to make it more catholic in its fellowship, more productive
of good in its tendencies. The author states that the subject of the
following discourse was not discussed by the Society, owing, probably,
to the lateness of the hour ; but it was ordered to be published and
largely disseminated nem. dissent., the meeting being very full."

The opinion of Dr. Jackson is, that Medical Colleges and Universi-
ties have too much power in the Association, State and County Socie-
ties too little, and hence it is proposed in the first article for the forma-
tion of a new constitution, that the Association be composed of dele-
gates from County Societies only. In reference to these Societies we
find the following language : " It is of primary importance to add to
the respectability of the County Societies ; this would be done by se-
curing the magnates of the profession, and causing them to take a hearty
interest in the business. These Societies are the Alpha and Omega of
the government of individuals ; they are the outposts of the profession,
and every means of rendering them respectable ought to be used. Our
great men, finding no other portal to the State Society, or to the great
Association, would attend them more faithfully, and greatly add to their
popularity and usefulness."

But if the " great Association" is to be composed of delegates from
County Societies only, we are at a loss to discover the enlarged republi-
can view which is sought to be established, and the absence of which
in the present organization so fearfully horrifies the author, unless it be
that County Societies are to embrace the body politic of the Medical
Profession throughout the country ; and this opinion we presently find
to be conveyed in the following language : " A Physician will not rest
night or day till he render himself worthy of a membership in the
County Society."

As the author informs us at the close of his address, that he has given
"hints rather than reasonings," we must leave the subject where we
found it, in a state of incubation !

100 The New-Orleans Medical and Surgical Journal.

The Thirteenth Annual Report of the Ohio Lunatic Asylum, by S.
W. Smith, M. D., Superintendent, is an elaborate paper, and contains
many useful suggestions and recommendations for the management of
similar institutions, as well as a thorough exposition of the affairs, finan-
cial and otherwise, of the Ohio Asylum.

Institutions of this character, having their origin in the philanthropic
principle of the amelioration of that unfortunate class of our fellow
creatures, who, from mental alienation are incapable of being self-sup-
porting agents in the great theatre of life, imperiously demand the fos-
tering aid of the State's government. The appeal which is now made
to the Ohio Assembly for an appropriation of five thousand dollars
above that of last year, and which is rendered more necessary by the
abolition of the class of pay patients, will doubtless meet a ready re-
sponse.

The Superintendent observes, that " on the 16th November, 1850,
there were in the Asylum 308 patients, of whom 170 were males, and
148 females. During the course of the year there have been received,
in addition, 133 males and 150 females, together 283 ; which number
added to 318, makes a grand total of 601, namely, 303 males and 298
females. These have either been discharged, in various conditions,
or are now in the house."

There were discharged during the year 300.

Assuming the average age of incurable insane persons to be 41^
years, the cost for care and support for each person before death, is
about $2000.

Dr. Ranney, Superintendent of BlackwelPs Island Lunatic Asylum,
New Yoik, observes in his last report, "At the present time 10 patients
may be selected in this institution, whose support has cost more than
$25,000, exclusive of expense for land, erection of buildings," &c.

Private establishments for the cure of the insane, the writer regards
as inadequate — a total and not a partial change is required, and hence
the value of large institutions, where discipline and regimen are more
strictly enforced, and where also the labor of the inmate can be made
available ; the increase of value to this Asylum from that source
during the year amounting to over $3000.

In the medical history of the cases, there is one class strikingly at
variance with the reports of Esquirol, the proportion of puerperal cases
admitted into the Salpetriere, during four years, being about 8 per
cent; whilst in the Ohio Asylum last year it was upwards of sixteen
per cent.

Reviews. — Addresses, Reports, etc.

191

Dr. Smith, fully aware of the difficulties and responsibilities which
surround his position as Superintendent of an insane institution, seems
quite prepared to sacrifice many of the comforts and conveniences of
life, whilst he becomes to the insane "their director and their friend."

In his History of the Art of Midwifery, Dr. Gardner, in his introduc-
tory remarks, inveighs against the attempt which has been made of late
years to educate females for the medical profession, more especially
with the view of training them to become midwives. His remarks on
this head are, however, more to preface the lecture than to disparage
the aid of women. It must, however, be admitted, that in certain qual-
ities and attributes, the "weaker vessel" is, by nature's great Archi-
tect, less designed to be a patient obstetrician, than by yielding to the
finer sensibility of her sex, to become the trainer and admonisher of
republican sons and daughters. Besides, even from antiquity, when
Greeks and Romans, and even the Hebrews called in midwives to
render service in the delivery of women, their aid was subsidiary, and
in France, at the present day, " where the midwife is educated at the
public expense, and where they are instructed as well as in any other
country in the world, the midwife is forbidden by law to perform anv
obstetrical instrumental operation herself, but is obliged to send for a
physician." Again, the improvements in the art of Midwifery have
not entered into the practice of the midwife, either ancient or modern,
any more than have the operative branches been made subject of study
and investigation.

Whether their aim has been, in the words of Ramsbotham, " equally
to escape the imputation of haste and indiscretion on the one hand, and
of delay and indecision on the other," their success in practice stands
more in painful, than in bold relief ; for on the authority of Dr. John
W. Francis, " the bills of mortality in London and Dublin attest, that
one in seventy of those women perish in childbirth who are in the
hands of midwives, whilst from the accounts of the lying-in-hospitals
in those very cities, which are under the care of male attendants, par-
turition is fatal to less than one half of the number."

A statement like the foregoing will naturally suggest that sometimes
" fools rush in where angels fear to tread !" G. T. B.

102 The New-Orleans Medical and Surgical Journal,

II. — The East Tennessee Record of Medicine arid Surgery. Edited
by Frank A. Ramsay, A. M., M. D. April, 1852. No. 1. Knox-
ville, Tenn. Published under the auspices of the East Tennessee
Medical Society.

Tennessee is evidently looking up, to use a popular phrase ; already
she claims too flourishing medical schools — one at Memphis and the
other at Nashville, and now we are called upon to announce the appear-
ance of a second medical journal, published at Knoxville, under the
editorial charge of Dr. Ramsay.

The number issued presents quite a handsome front, and embraces
100 pages, published every three months, at $2 per annum. It contains
seven original articles, all well written, and many of them o^ite instruc-
tive. The first is from the pen of our whilome associate and ever fast
friend, Dr. E. D. Fenner, — and like all his productions, indicates a real
love for the profession, and an anxious desire to forward its best inter-
ests.

The editor, Dr. Ramsay, spreads before the profession in this num-
ber, a long Report on the Epidemics of Tennessee and Kentucky. It
abounds in valuable suggestions and useful information on a great vari-
ety of diseases.

We cordially welcome this newjournal to our list of exchanges.

III.* — The Principles of Surgery. By James Miller, F. R. S. E. F,
R. C. S. E., &c, &c. Third American from the second and enlarged
Edinburgh edition. Illustrated with 240 wood engravings. Edited
by F. W. Sargent, M. D. 1852.

The Edinburgh Professors, as in days of yore, still hold a high rank
among the medical savans of the age. Conservative in their theory
and practice, they may be justly considered the best teachers to the
young almost any where to be found at the present day. Reared and
educated on classic ground, they constitute excellent models in the art
of composition, in force of diction, chastity of style, and that directness
and brevity of expression by which true science should be made man-
ifest to the world.

Professor Miller's Principles of Surgery — it should have been of
4i Medicine"— have already reached the third American edition — thug

Reviews. — *Drs. Bernard & Huette on Operative Surgery. 103

indicating at once its great popularity and its intrinsic value. This
edition is far superior, both in the abundance and quality of its material
to any of the preceding. We hope it will be extensively read, and the
sound principles which are herein taught, treasured up for future appli-
cation.

The book is indeed invaluable to both the student and active prac-
titioner ; it is worth a cargo of compendiums, so styled, and should be
made to supersede the catch-penny trash that is thrust into the student's
hands the instant he crosses the threshold of many of our medical
schools. The illustrations and text are fair specimens of Philadelphia
manufacture, and detracts nothing from the value of the doctrines therein
taught. The work takes rank with Watson's "Practice of Physic" —
it certainly does not fall behind that great work in soundness of princi-
ple or depth of reasoning and research. No Physician who values his
reputation or seeks the interest of his clients, can acquit himself before
his God and the world, without making himself familiar with the
sound and philosophical views developed in the foregoing book. It may
be had of J. B. Steel, 60 Camp street.

IV. — Illustrated Manual of Operative Surgery and Surgical Anatomy.
By MM. Bernard and Huette. Edited by Van Buren and
Isaacs. New York. Part II. 1852.

We are indebted to the publisher, H. Bailliere, for the Second Part
of Bernard and Huette's Operative Surgery— the First Part having
been received and duly noticed in our May issue.

The work, we are informed in a note, "will be speedily completed,"
when it will be one of the best works of the kind in any language. The
various surgical operations are here briefly described and illustrated
with most superb steel engravings— so distinct and perfect in fact, that
when gazing on them and watching the knife as it glides through the
tissues, we instinctively look to see the blood gush from the divided
vessels.

When we shall have received the work complete, we shall have more
to say of its value. It may be had in this city.

104 The New-Orleans Medical and Surgical Journal.

V, — A Complete Treatise on Midwifery, or the Theory and, Practice of
Tokology. Including the Diseases of Pregnancy, Labor, and the
Puerperal stale. By Alf. A. L. M. Velpeau, M. D. From the
French. By Chakles D. Meigs, M. D., etc., etc. With illustra-
tions. Philadelphia, Lindsay and Blakiston, 1852.

Of M. Velpeau it may be justly remarked, that he has no superior at
the present day in his profession. As a writer on Surgery and an ope-
rator, he ranks with the most illustrious names in Europe; and his
work on Tokology is fully equal to any on the same subject. How
extensive his knowledge — how varied his researches in medical sci-
ence ! With equal exactitude of knowledge he traces the develop-
ment of the ovum from the moment of its first vivification, with the for-
mation of callus in fractures — the reparation of structures in the
soft parts — and on all these various subjects he is equally well informed
— exact and accurate.

The style of M. Velpeau as a writer, is to us exceedingly fascinating;
and we first acquired a fondness for obstetrical science by reading his
work on the subject.

The present edition is much improved over any of the preceding —
and the illustrations more numerous and better executed. Dr. Meigs
has performed his part of the work with his usual ability.

White has the work for sale.

VI. — An Address on the occasion of the Centennial Celebration of the
Founding of the Pennsylvania Hospital. Delivered June, 1851. By
Geo. B. Wood, M. D.

We are indebted to the accomplished author for the above Address
—which numbers 141 pages — is handsomely finished, and abounds in
statistical facts and other matters pertaining to the history of one of the
oldest and best regulated Hospitals in the United States.

The Pennsylvania Hospital is a model for all similar institutions ;
and the account given of its early endowments — struggles — resources,
etc., by Dr. Wood, is exceedingly interesting, and written in that plain

Reviews. — Dr. Reese on Physiology. 105

and finished style characteristic of all the literary productions of the
author.

We refer those interested in the history of such institutions to the
Address for much useful information.

Doctor Wood will please accept our thanks for this mark of his
courtesy.

VII. — An Analysis of Physiology. Being a condensed view of its im-
portant Facts and Doctrines, designed especially for the use of Stu-
dents. By John J. Reese, M. D., Lecturer on Materia Medica
and Therapeutics in the Medical Institute of Philadelphia, Physician
to Will's Hospital, Fellow of the College of Physicians. Second
edition, revised and enlarged. Philadelphia: Lindsay & Blakiston.
1852. 12mo. pp. 368.

To the enterprize and courtesy of Mr. J. B. Steel, 60 Camp street,
we are indebted for a copy of the second and very recent edition of this
small but very valuable compend of physiological science.

By the untiring experiments of physiologists, never more industrious,
perhaps, than at the present day, frequent revisions and republications
of conveniently arranged manuals, are rendered necessary, if we would
ascertain what is actually known or received by the profession. Since
the period at which the first edition of Dr. Reese's work appeared,
many new and important facts have been developed ; and doctrines
which were then only hinted at, or had never been conceived, may now
be considered as sanctioned by the approbation of the highest names.
Consequently, this edition of the Analysis has undergone an entire revi-
sion, has been re-written and much new matter added. We suppose
that for the present, the student of medicine will find it a valuable aid
in revising his studies ; but the time is not distant when important and
even radical changes, exploding some of the oldest and apparently best
settled doctrines, and substituting for them those as little likely to meet
a gracious reception, as were the teachings of Callileo and Hervey in
their day, are to be presented for consideration and adoption. The pre-
sent prospect is, that among other important changes working, and to
be wrought out, by this spirit of severe and restless investigation, our
views of the functions of the nerves, as developed and taught by Sir

106 The New-Orleans Medical and Surgical Journal.

Charles Bell, are destined to become essentially altered, if not proved
a splendid fallacy.

In the perusal of the volume before us, we have been much gratified
at the condensed yet lucid manner with which what is known or received
as true, is exhibited; and we had marked a number of passages as
illustrative of this excellence, intending to cite them in detail. As we
have, however, already been betrayed into an unusually lengthy notice
of it, we must forbear. It is well worth the attention of either the stu-
dent who has much else to read, or of the practitioner who has, or
wishes to have, much else to do. J. S. C.

VIII. — Essays on Life, Sleep, Pain, etc. By Samuel Henry Dick-
son, M. D., Professor of Institutes and Practice of Medicine in the
Medical College of the State of South Carolina. Philadelphia ;
Blanchard & Lea. 1852. pp.301. 12mo:

Dr. Dickson's reputation as a lecturer is well known, and the ease
and grace of his compositions are pre-eminent in the little work
before us.

In his Essay on Life, our author, in common with others, who have
written on the same subject, seems perfectly aware of its difficulty,
and after exposing the fallacy of those who endeavor to show that life
is the consequence of chemical combinations and affinities, contents
himself, as we think wisely, in considering it a principle emanating
directly from the Supreme Being. He differs from most modern Phy-
siologists in believing organization to be the result of life, and not that
life is the result of organization.

The Essays on Pain, Sleep, etc., are interesting, and evince much
research. That upon Hygiene is invaluable. It is almost entirely
practical, should be in the library of every family, and often consulted.
The remarks concerning the ages at which children should commence
going to school, and the hours of their attendance, are admirable and
we are sorry we cannot make room for their insertion.

The last Essay is entitled " Death," and in this the author has scat-
tered so many flowers of language from his own gifted and highly
cultivated mind, as well introduced so many elegant quotations from
others who have thought and written upon this solemn theme, as to

Reviews. — Dr. Graham on the Elements of Chemistry. 107

make the contemplation of a subject which instinctively we dread, ra-
ther agreeable.

The chief complaint which can be urged against Dr. Dickson's
writings is, their rarity. We hope to see this amended.

The book may be had at the establishment of Mr. J. B. Steel, No.
60 Camp street, to whose courtesy we are indebted for an early posses-
sion of the volume before us. J. S. C.

SX. — Elements of Chemistry, including the application of the science
to the Arts. By Thomas Graham, F. R. S., Professor of Chemis-
try in University College, London, etc. Second American, from an
entirely revised and greatly enlarged English edition. With numer-
ous wood engravings. Edited, with notes, by Robert Bridges, M.
D., Professor of Chemistry in the Philadelphia College of Pharmac}r,
Lecturer on Chemistry in the Philadelphia Association for Medical
Instruction, etc. Philadelphia : Blanchard & Lea. 1852. Part
1st. pp. 430. 8vo.

It is well known to the profession, and to many others who make this
department of the natural sciences their study, that on the first appear-
ance of Dr. Graham's " Elements of Chemistry," it obtained an imme-
diate and well merited reputation. The labor since bestowed by its
indefatigable author in his copious selection of facts from ^li reliable
sources, their excellent arrangement, the clear expositions of theoreti-
cal views, and the acquaintance manifested throughout with special
treatises on all the kindred sciences, have combined to place the present
edition far in advance of its predecessor. This is proved, so far as the
popular estimate is concerned, by the fact that the "numerous inquiries
for the new edition of Graham's Chemistry'' have induced the publish-
ers to issue separately the first half of the? work. We are glad to note
that they have done this in a cheap farm, because, inasmuch as it in-
cludes the application of the science to the arts, it is thereby more avail-
able to all who choose to pursue their daily vocations by the superior
and surer lights of science.

We shall anticipate with pleasure the completion of the work, and
hope to possess the whole in a single volume.

To the politeness of J. B. Steel, 60 Camp street, we are indebted
for the part before us. J. S, C.

|p art lourtS).

MISCELLANEOUS MEDICAL INTELLIGENCE.

1 — Proceedings of the Fifth Meeting cf the American Medical Association — Held

at Richmond, Va., May 4th, 1852.

Through the extreme courtesy of Dr. Gooch, Editor of the Stethoscope, we
have been put in possession of the proceedings of the National Medical Asso-
ciation, recently convened at Richmond, Va. The following is the list of Del-
egates who were present and took their seats as such :

From Maine 2 ; New Hampshire 1 ; Massachusetts 17 ; Rhode Island 6 ;
Connecticut 9 ; New York 28; New Jersey 8 ; Pennsylvania 33 ; Delaware 3;
Maryland 10 ; Virginia 90; North Carolina 5; South Carolina 13 ; Georgia 4;
Alabama 4 ; Louisiana 2 ; Tennessee 2 ; Kentucky 8; Ohio 10 ; Michigan 1 ;
Illinois 3 ; Missouri 6; Iowa 1; District of Columbia 6 ; U. S. N. 1; Foreign

2— 275,

After which the nominating committees previously appointed designated the
following as oncers of the Association for the ensuing year :
For President^-Beverley R. Wellford, of Virginia.

For Vice Pres^\^_J0nathan Knight of Conn ; James W. Thompson of
Delaware ; Thomas Y. Simons of South Carolina ; and Charles A. Pope of
Missouri.

For Treasurer— Dr. Franks Condie of Pennsylvania.

A resolution was adopted, granting the "American Medical Society in Paris"
the right to be represented in the Association.

The committee on Prize Essays awarded the prize to Dr. Austin Flint of
Buffalo, for his essay " On variations^ pitch in Percussion and Respiratory
Sounds, and their application to Physical Jbi.agnosis. This Essay will be pub-
lished in the next volume of the Transaction?, when we shall have the plea-
sure of reading it. We congratulate Dr. Flinlon his success in this conflict
of mind with mind.

Dr. N. Pinckney, of the U. S. Navy, read a memorial to the Association,
which he had prepared to present to Congress, on the subject of assimilated
rank, ^fter the reading was over, a series of resolutions were unanimously

Miscellaneous Medical Intelligence, 109

adopted, endorsing the views of Dr. Pinckney, and urging upon Congress and
the Heads of Departments the claims of the medical cjrps to promotion in the
Navy.

A committee was appointed to transmit the resolutions with the memorial of
Surgeon Pinckney, to the presiding officers of hoth Houses of Congress.

Dr. Simons of South Carolina offered the following important preamble and
resolutions, which were adopted ;

The accumulation of passengers who are emigrants, crowded in ships coming to
our shores from foreign ports, having in a great many instances numerous cases of
aggravated fever, many of which prove fatal, and likewise producing similar results
at the lazarettoes, and even cities; the number, likewise, of sick arriving from Ca-
lifornia, and some of the South American ports, and the fact that none of these ves-
sels are required by law to have physicians or surgeons on board, seem worthy of
our attention as conservators of health, and as an act of humanity and duty on the
part of the American Medical Association, to bring these facts respectfully to the
consideration of Congress, and to request its legislation thereon :

Be it therefore resolved, That the American Medical Association do memorialize
Congress to require all vessels carrying steerage passengers on the sea to have a
surgeon on board.

Resolved further, That a committee of this Association be formed to draw up a
memorial to Congress, making such suggestions as it may deem fit as regards the im-
portance of this measure.

The chair appointed the following committee to memorialize Congress on the
subject matter embraced in the foregoing preamble and resolutions, viz: Drs.
T. Y. Simons of S. C, Pope of Mo., Thompson of Del., Flint of Ky., and
Mauran of R. I.

A resolution was adopted, repudiating the rights of colleges exclusively of
Dentistry and Pharmacy, to send delegates to the Association.

A resolution was introduced by Dr. Corbin of Virginia, and adopted, accred-
iting one member from each State represented in the Association to travel in
Europe, and to report upon foreign medical affairs to the Association.

Dr. J. M.Smith of New York, chairman of the committee on nominations,
presented the following report, which, on motion of Dr. Corbin of Virginia, was
adopted :

The committee of nominations, in fulfilling the duty of their appointment, propose
to continue most of the special committees appointed by the Association in May,
1851, and to appoint several new special committees ; they therefore submit the fol-
lowing list of chairmen of special committees, with the subjects which have been
committed to them :

1. Dr. D. F. Condie of Philadelphia: On the Causes of Tubercular Disease.

2. Dr. James Jones of New Orleans: On the mutual relations of Yellow and Bili-
ous Remittent Fever.

3. Dr. R. S. Holmes of St. Louis : On Epidemic Erysipelas.

4. Dr. C. D. Meigs of Philadelphia: On acute and chronic disease of the Neck of
the Uterus.

5. Dr. J. P. Jervey of Charleston : On Dengue.

6. Dr. Daniel Drake of Cincinnati : On Milk Sickness, so called.

7. Dr. A. Lopez of Mobile : On the prevalence of Idiopathic Tetanus.

8. Dr. G. B. Wood of Philadelphia : On diseases of the Parasitic Organs.

9. Dr. R. D. Arnold of Savannah : On the physiological peculiarities and diseases
of Negroes.

10. Dr. Joseph Carson of Philadelphia : On the Alkaloids which may be substi-
tuted for Quinia.

110

The New -Orleans Medical and Surgical Journal.

11. Dr. S. D. Gross of Louisville : On the results of surgical operations for ths
relief of malignant diseases.

12. Dr. James R. Wood of New York : On statistics of the operation for the re-
moval of Stone in the Bladder.

13. Dr. Alexander H. Stevens of New York : On sanitary principles applied to
the construction of dwellings.

14. Dr F. Peyre Porcher of Charleston : On toxicological and medicinal properties
of our Cryptogamic Plants.

15. Dr. G. Emerson of Philadelphia : On agency of the refrigeration produced
through upward radiation of heat as an exciting cause of disease.

16. Dr. Henry J. Bigelow of Boston : On the best means of making pressure in
reducible Hernia.

17. Dr. A. T. B. Merritt of Richmond; On Cholera and its relations to Congestive
Fever ; their analogy or identity.

18. Dr. Usher Parsons of Providence : On displacements of the Uterus.

19. Dr. F. H. Campbell of Augusta, Ga : On Typhoid Fever.

20. Dr. Worthingtoa Hooker of Connecticut : On the Epidemics of New England
and New York.

21. Dr. John L. Atlee of Lancaster, Pa. : On the Epidemics of New Jersey, Penn-
sylvania, Delaware and Maryland.

22. Dr. Robert W. Haxall of Richmond, Va. : On the Epidemics of Virginia and
North Carolina.

23. Dr. W. M. Bolingof Montgomery, Ala: On the Epidemics of South Carolina,
Georgia, Florida and Alabama.

24. Dr. Edward H. Barton of New Orleans : On the Epidemics of Louisiana,
Mississippi, Texas and Arkansas.

25. Dr. W. L. Sutton, of Georgetown, Ky. : On the Epidemics of Tennessee and
Kentucky.

26. Dr. Thomas Reyburn of St. Louis: On the Epidemics of Missouri, Illinois,
Iowa, and Wisconsin.

27. Dr George Mendenhall of Cincinnati : On the Epidemics of Ohio, Indiana,
and Michigan.

Committee on Volunteer Communications : Drs. Joseph M Smith, J. A. Swett,
W. Parker, G. Buck and A. C. Post, of New York.

Before the Association adjourned, the following resolutions were adopted,
viz :

1. Resolved, That the elegant, varied and generous hospitality which the Asso-
ciation has enjoyed during its present session, calls for its hearty and unanimous
thanks, with the assurance that it can never forget an entertainment unrivalled even
among the festivities of the "Old Dominion."

2. Resolved, That the thanks of the Association are hereby presented to the
Medical Society of Virginia, to the medical profession and citizens of Richmond, to
the trustees of the "United Presbyterian Church," to the managers of the Danville
Railroad, and to the several public institutions of this city, for the hospitable care of
these bodies to promote the comfort and amusement of the Association.

3. Resolved, That the Association returns its thanks in an especial manner to the
committee of arrangements for the zeal, intelligence and good taste displayed in per-
forming its numerous and important duties.

On motion, the Association adjourned to meet again in May next, in the
city of New York. (Ed.)

Miscellaneous Medical Intelligence.

Ill

NITRATE OF SILVER IN THE DIARRHOEA OF CHILDREN.

Dr. Cenas reports in the June No. 1852. of the New Orleans Medical Regis-
ter, several cases of obstinate diarrhoea in children, for which he prescribed the
crystalized nitrate of silver, with almost immediate beneficial effects. In the
course of 24 hours the discharges ceased to be so frequent, and assumed a
much more healthy appearance. The cases he names were undoubtedly ob
stinate,but all speedily yielded to the efficacy of the medicine. He gave (we quote
from memory) one grain of the crystalized nitrate of silver in one ounce and a
half of mucilage gum Arabic ; of this the little patient took teaspoonful doses
every four to six hours, according to the frequency of the discharges and the
intensity of suffering. He gave it by the mouth only ; it was not employed
by injection. (Ed.)

II. — On Abortion and Transf usion of Blood.

BY DR. ROUANET.

Translated from U Union Medicate de la Louisiane.

I received lately, at one o'clock in the morning, a visit from a fellow-prac-
titioner, who was very uneasy about the condition of one of his patients. Hav-
ing been confined about the middle of her pregnancy, the midwife who attended
her had been unable to deliver her entirely of the placenta. The portion of the
placenta which remained in the womb, caused during the last four days the
loss of so great an amount of blood, as to threaten seriously the life of the pa-
tient. All the means usually resorted to in such cases having failed, the prac-
titioner had resolved to resort to transfusion of blood, which has been practised
for some time in Europe. It was with this disposition of mind that he came
in the middle of the night to demand my assistance. . Whilst we were making
the required preparations, 1 related to him the following case.

Called one day to a house in the Rue Vieille du Temple, in Paris, I saw be-
fore me a woman, by profession a fruit-seller, who was dying of hemorrhage,
in consequence of an abortion which took place about the sixth week of her
pregnancy. Two physicians had been called before me to treat her, and had
considered her case so desperate, that from prudential motives they thought
proper not to interfere. The least interference, they thought, would precipitate
a fatal termination, and cause the patient to expire in their hands. What is
there to do, in truth, when the breathing of a patient is barely perceptible, the
pulse hardly to be felt, the skin pale and cold ? What may he dare when death
seems so imminent? But nevertheless, what risk then in trying some expe-
dient? This last consideration emboldened me; I attempted to deliver the
woman. Difficulties unforeseen came near defeating my efforts. The womb,
very slightly developed, and very moveable, yielded in spite of my pressure on
the hypogastrium, to the movement of the finger, introduced into the cavity of
the organ, while it sought to detach the placenta, which was strongly adherent.
After painful effort I despaired of success, when the idea occurred to me to
seize the placenta by means of a pair of polypus forceps of a suitable length.
The fore part of the instrument, deprived of its teeth by a file, was glided by its
flat surface on the palm or aspect of the right index finger, the third phalanx

112 The New-Orleans Medical and Surgical Journal.

of which was in the womb. Arrived there, the instrument described a quarter
turn on its axis, which permitted its being opened vertically on the pulp of the
finger; then it was closed on the placenta, which it seized and held, whilst the
finger detached it from the internal surface of the organ. When the operation
was over the blood ceased to flow, the patient gradually recovered from the
shock her strength had received, and afterwards got perfectly well. The same
forceps have served me a great many times since under similar circumstances,
excepting that the cases were not so severe.

The practitioner begged me to bring them with me, and we went to see his
patient, who seemed to be suffering a great deal. The plugs previously intro-
duced having been removed and the clots taken away, I proceeded to the appli-
cation of the forceps, and at the end of a few minutes the placenta was re-
moved and all danger had entirely passed.

"This is much better than transfusion," said my friend.

There is no doubt that transfusion is useful under certain circumstances.
It is the abuse of it which should be prevented. Anterior to the delivery of
the placenta, transfusion appears to me generally but little reliable — dangerous
even for certain physicians, in whom it might inspire a fatal confidence. We
should except those cases where the removal of it might be really impractica-
ble. When the uterus, completely emptied, ceases to furnish blood, it is rare,
I believe, for the patient not to return spontaneously to health, as in the case of
the fruit-seller. If it should turn out otherwise, transfusion would be perfectly
indicated.

I learned some days since only from a fellow-practitioner, who has made re-
searches into the history of instruments, that the method which I used had
been employed by Levret. When we consider the frequent and serious dan-
gers to which premature delivery gives rise, we are at a loss to understand
how this powerful ally in overcoming them is not of more general use in the
practice of midwifery. The forceps " a faux germe" of Levret only differs
from the polypus forceps in the wideness of its jaws— an advantage which is
very questionable, in my opinion. Besides, both instruments are straight,
which is, under certain circumstances, an inconvenience. It is my intention
to do away with it in a special instrument which I intend to have made,
the branches of which may be introduced separately, after the fashion of mid-
wifery forceps.

III. — Remarkable Case of Abstinence.

Abstinence is most frequently the concomitant and consequence of melan-
cholia. It is a means of extinguishing life. To those who dread suffering and
struggles, it holds out the hope of a slow and painless death. To others, the
fear °of death suggests the same course. They prefer inanition to arsenic.
They defeat and glory in defeating, the machinations and malice of enemies,
and by self-inflicted misery and suffering. Of the patients admitted, eleven
have taken food reluctantly, and in insufficient quantity, have refused all nour-
ishment, or have been fed. Seven were females ; four males. In six of these
this resolution could be distinctly traced to melancholia ; in one to disease of
the stomach, and in the others to delusion. Of the latter, one was commanded
by the Admiralty to starve ; a second could not swallow from repletion ; a third
seemed to doubt "the reality of the viands presented; and a fourth was prevented
by the peculiar structure of the abdomen.

Miscellaneous Medical Intelligence.

113

A very instructive example of this symptom of mental obliquity was alluded
to in the last report, and is still under treatment. This lady conceives that the
ordinary diet of the establishment consists of human remains, pounded and
prepared in a huge instrument, which she calls a murder machine, which daily
immolates victims, and yields hideous repasts to those who remain. She ob-
stinately declines to participate in this cannibalism, and has not swallowed food
since the 13th October, 1849. At first she was fed with great difficulty, and
in defiance of the most strenuous and determined opposition, by means of the
naso-cesophageal tube; but latterly her resistance has been less violent, although
her purpose is as inflexible as ever. She must be carried to the spot where her
meals are administered, but having thus demonstrated her consistency, she
sometimes assists in holding the dish which contains the food about to be in-
troduced forcibly into her stomach. By an enlargement, and modification of the
ordinary stomach pump, semi-solid food has long been given, and wilh the
exception of those steps in the process of digestion which depend on mastica-
tion, the requirements of nature are closely imitated. The result has been
most satisfactory.

When artificial support became indispensable, the patient was emaciated,
debilitated and haggard. She is now blooming and robust. As the case is sin-
gular, if not unique, a list of the articles of diet is quoted, and the quantities
given at different times.

On the 6th March she was adequately supported by the following allowance
— Brown soup 12 ounces; bread 4 ounces; milk 14 ounces; arrow-root 2
ounces ; eggs 2; cod liver oil 1 ounce. On the 19th October her diet consisted
of bread or rice 1 lb.; mince meat 16 ounces ; soup 20 ounces ; tea 12 ounces;
milk 3 ounces; ale 1 ounce ; cod liver oil 1 ounce.

At various times the articles have been varied in the following manner —
1. Arrow root with eggs and milk ; 2. Hare soup and grated meat ; 3. Kidney
soup with grated meat ; 4. Grated cheese with soups; 5. Minced meat, soups,
and bread ; 6. Rice and milk ; 7. Pea soup and bread ; 8. Tea, and bread
soaked; 9. Coffee and bread soaked; 10. Sago, eggs and milk ; 11. Brown
soup and bread ; 12 Calves' foot jelly and bread; 13. Brown soup and grated
carrots or beet root ; ale or lemonade being given as drink with these. In this
catalogue will be found cod liver oil. It was added partly from the apprehen-
sion that the patient might become phthisical, partly in the expectation that it
might perform the same service in the cachetic state which imperfect nour-
ishment creates, and which precedes phthisis, which it does when the disease is
established.

(Reports British Lunatic Asylums.)

IV. — Chloroform applied Locally in Fractures and Dislocations.

BY N. H. HURLBUT, M. D-

I would call the attention of the profession to the local application of chloro-
form to remove pain and induce insensibility of parts to be operated upon. I
have made use of it for two years past as a local remedy with the most happy
results. In cases of comminuted fractures, producing, as it does, insensibility
and relaxation of parts, it enables the surgeon to overcome the resistance of
muscles, and to reduce fractures without pain or suffering to the patient. In

114 The New-Orleans Medical and Surgical Journal.

dislocations, I have no doubt its local application would be attended with the
same happy results. I have used it in a similar manner in folons, neuralgia,
etc. The best mode of application, I think, is to saturate a cloth with it, apply-
immediately, and over that a piece of oil silk, to prevent evaporation, allowing
it to remain some four or rive minutes, which will be sufficient. A second
application may be necessary in fractures of the superior third of the femor, or
in dislocation of the same bone.

The frequent deaths reported from the inhalation of chloroform , has induced
me to call attention to its local use. If in the hands of others it shall prove' as
safe and efficient a remedy as it has in mine, I shall be amply rewarded.

Chicago, April 5, 1852.

(Norih-iuestern Med. and Surg, Jour.)

V. — Pressure upon the Abdominal Aorta in Uterine Hemorrhage- — its success.

Prof. Howard, — who, by the bye, has distinguished himself by his surgical
feats, — reports in the May No. of the Ohio Medical Journal the following very
instructive case :

On the night of the 7th inst. Mrs. L. was taken in labor. At eig'ht o'clock
on the following morning I found it progressing naturally, with a vertex pre-
sentation, os uteri dilating. At eleven o'clock she was safely delivered of a
fine daughter. The uterus speedily contracted, accompanied with considerable
pain. In about 20 minutes 1 found the placenta in the vagina. On removing
it, a gush of blood occurred which startled me. In a few moments she re-
marked that she could not see, and the next, said she was very faint, and be-
gan to gasp for breath. In a moment my hand was upon the hypogastrium,
where I found the uterus under the influence of prpssure and friction, occa-
sionally making efforts at contraction ; but relaxation of its walls prevailed, and
I could hear the blood flow from the vagina. The woman was evidently dying
from uterine hemorrhage, and what was to be done ? Should I apply pressure,
friction and cold to the hypogastrium ? I had done this without any substan-
tial effect. Should I give ergot, opium, sugar of lead ? There was no time
certainly for these to act. Should I, according to the teachings of my hon-
ored preceptor and late colleague, Prof. Childs, apply the tampon, for the pur-
pose of kindling up a "harmony of function," by "establishing the necessary
relations between the uterus and its contents ?" The loss of half a pint more
of the vital fluid would insure death to my patient, already in articulo mortis.
The womb, now completely relaxed, wrould receive half a gallon of blood before
it would "cry enough." This measure was out of the question, At this crit-
ical moment, the thought of pressure upon the abdominal aorta, first suggested
by a writer in one of the cotemporaries of this Journal, whose name I have
not time to ascertain, entered my mind. The pressure was applied with my
lingers almost as soon as thought of, and I could succeed with perfect ease in'
completely arresting the flow of blood through this large vessel to the lower
half of the body. The pulsation in this artery was a mere wave, which was
barely perceptible. In an instant after the pressure was applied flooding
ceased; and in three minutes I could see a decided change in the appearance
of my patient. The cadaveric countenance began to disappear, and the color
appeared, though slightly, in her lips. Though delirious and half convulsed,

Miscellaneous Medical Intelligence.

115

from want of blood in the brain, in ten minutes her consciousness returned,
and in half an hour, reaction, yet feeble, was established. The uterus now
contracted upon its contents, and good sound " after pains," in the course of an
hour, insured the safety of my patient.

In my own mind, I have no doubt that pressure upon the aorta was instru-
mental in rescuing Mrs. L. from the grave. It seems to me nothing else could
have saved her ; as there was no power in the uterus of itself to contract, and
thus to close the open mouths of its bleeding vessels. She would have as
certainly bled to death as if there had been an opening through the walls of the
heart i

VI. — Wound of Abdomen and Intestines.

BY ISRAEL A. COONS, M. D., OF DAYTON, O.

About the middle of last November, in consultation with Drs. Treon, Wea-
ver, and Legg, I saw Mr. , of this county,. aged about 40, occupation,

landlord, of temperate habits, who had been stabbed, about five hours before
my arrival, with a common pocket-knife, in the superior and internal portion
of the right iliac region. On examination, we found a perpendicular wound
in the parieties of the abdomen, and the intestines and the omentum protruding
to the size of a man's double fist. The protruding portion of the ilium was
wounded in two places ; in one the coats were not all perforated ; the other
was, in a longitudinal direction, and in extent about half an inch, allowing the
free escape of the contents of the bowels. On an effort being made it was
found impossible to reduce the protruding intestine without enlarging the ex-
ternal opening in the abdomen, which was done in an upward direction and the
intestine reduced, after properly closing the cut in the ilium, by Glover's su-
ture, and cutting the ligature short off.

Two stitches were taken in the external wound, adhesive compress, and
rollers applied. The patient was placed in bed, and nothing but the simplest
fluid diet allowed. Opiates were given to allay pain and quiet the intestines.
Slight reaction came on the next day, with some pain and tympanitis, which
were readily subdued by mild doses of Dover powder, and an injection to move
the lower bowels. In about three weeks the patient was doing well ; was
allowed to be up, and at the end of six weeks the wound was nearly healed.

(Ohio Med. and Surg. Jour.)

Yll.—Ofthe Sale of Poisons.

In the May No. for 1852 of our excellent cotemporary, the Ohio Medical
Journal, we find the following law in regard to the sale of poisons, in full force
in the State of Ohio. The public, it seems, is indebted to Dr. Vattier of Cin-
cinnati, for this law ; and we hope every State in the Union will follow the
example of Ohio. In Louisiana no such law is in force; and in consequence
we are called upon almost weekly to report one or more deaths caused by tak-
ing some poisonous preparation. Some of our apothecaries will sell the most
deadly poisons to servants and other irresponsible persons, without the prescript

116 The New-Orleans Medical and Surgical Journal.

tion of a Physician ; now all this is wrong, and should be checked by the most
stringent laws.

The following is the act regulating the sale of poisons in the State of
Ohio:

Sec. 1. That it shall not hereafter be lawful for any apothecary, druggist, or
other person, in this State, to sell or give away any article belonging to the
class of medicines usually denominated poisons, except in compliance with
the restrictions in this act.

Sect. 2. That every apothecary, druggist, or other person who shall sell or
give way, except upon the prescription of a physician, any article or articles
of medicine belonging to the class usually known as poisons, shall be re-
quired—

1 st. To register in a book kept for that purpose, the name, age, sex and color
of the person obtaining such poison.
2d. The quantity sold.
3d. The purpose for which it is required.
4th. The day and date on which it was obtained.

5th. The name and place of abode of the person for whom the article is in-
tended.

6th. To carefully mark the word " poison" upon the label or wrapper of
each package.

7th. To neither sell nor give away any article of poison, to minors of either
sex.

Sec. 3. That no apothecary, druggist, or other person shall be permitted to
sell or give away any quantity of arsenic less than one pound, without mixing
either soot or indigo therewith, in the proportion of one ounce of soot or half an
ounce of indigo to the pound of arsenic.

Sec. 4. That any persons offending against the provisions of this act shall be
deemed guilty of a misdemeanor ; and upon conviction thereof, shall be fined in
any sum not less than twenty, nor more than two hundred dollars, at the dis-
cretion of any court of competent jurisdiction.

VIII— SELECTED ITEMS OF MICROSCOPIC OBSERVATION.

Being in explanation cf thirty Lithographic Figures, relating to the structure of

Blood.

BY J. L. RIDDELL, M. D.
Prof. Chemistry in Med. Dep. Univer. La.
( Continued from the March Number of this Journal.)

TAB. XL

[Magnified 1000 diameters.]

Blood of the alligator,procured by Dr. Hale at the vivisection of an alligator,
May 12th, by Dr. B. Dowler.

112, 113,114. Natural appearance of the red corpuscles, floating in the
serum ; no internal structure being apparent.

TAB .XI

From, nature- eigr. on 3 tone ~by J.Z JPlloAbII

tab m

lit

TABJCffi

TAB . XTV

Miscellaneous Medical Intelligence.

117

115. Red corpuscles seen edge- wise.

116, 117. Nuclei made apparent in the red corpuscles, by adding to the se-
rum a solution of carbonate of soda. The pointed outline of No. 116 is not
due to the reagent added ; it is frequently witnessed in the normal blood.

118, 119. By bringing in contact with the blood a watery solution of bro-
mine, weak tincture of iodine, or a solution of chloride of platinum, the mem-
branous expanse of the red corpuscles exhibits a granulated appearance, as here
shown. (Pallium vesiculatum. Vide 125, 126.)

120. White corpuscles floating in the serum ; apt to be seen in groups, as
they seem to manifest a segregative tendency.

TAB. XII.

[1000 diameters.']
Blood of the Amphiuma tridactylum, Cuv.

121. Natural appearance of red corpuscle, seen upon its broad surface ;
the nucleus apparent.

122. The red corpuscle seen edge-wise.

123. Red corpuscle with a pointed extremity. These, and others with
both extremities pointed, are not unfrequent. More rarely these attenuated
ends are symmetrically bulged out and rounded off.

Memorandum- It is not probable that larger blood corpuscles have ever
been examined, than these of the Amphiuma, they frequently exceeding in
length one two hundred and fiftieth part of an inch. The nearest approach
on record, so far as I am aware, is the blood of the Siren, a batrachian reptile
closely allied to the Amphiuma, in which the corpuscles are reported by Gulli-
ver to be one four hundred and twentieth of an inch long. Owen, (Lectures
Comp- Anat. II. p. 13) represents the corpuscles of the Siren blood to be one
three hundreth of an inch long. The Amphiuma blood corpuscles are not only
longer, but judging from the figures in Owen, and in Hassall's Micros. Anat.,
much broader in proportion, and therefore considerably larger. Their average
size, cubically measured, is more than 1200 times as great as the corpuscles of
human blood.

124. White corpuscles of Amphiuma blood.

TAB. XIII.

[1000 diameters.]
Blood of the Amphiuma tridactylum, Cuv.

J 25, 126. Appearance of the red corpuscle after adding to the blood a so-
lution of common salt, and subsequently adding acetic acid, according to the
valuable plan of Prof. James Jones. Other methods of chemical treatment
(118, 119) bring out similar appearances, but not always with the same dis-
tinctness. We here have 1st, a composite cell, strictly analogous to other
animal and algoid cells ; namely, the nucleus, containing numerous nucleoli,
which in turn are visibly filled with nucleolar and granular contents ; 2d, the
vesiculate mantle, 'pallium vesiculatum, or specific peculiarity of a red corpus-
cle, containing in its texture a great multitude of minute spherical vesicles of

118 The New-Orleans Medical and Surgical Journal.

similar size ; being the site of the red color of the blood, and the substance
which probably serves as an oxygen bearer, from the lungs to the capillary
tissues.

127. Rough outline of the Amphiuma tridactylum, Cuv., a Batrachian rep-
tile, common in the muddy swamps of the Louisiana Delta, often seen four or
live feet long, and almost black in color. The negroes about New Orleans
call it the Congo snake.

TAB. XIV.

[1000 diameters.']

128, 129. Natural appearance of the red blood of the tree frog. (Hyla ar-
bor ea, Lau.)

1 30. White corpuscles in the blood of the tree frog.

131. Red blood corpuscle of the tree frog, treated with salt and vinegar
(125, 126), so as to make apparent the pallium vesiculatum. which here, from
the minuteness of the vesicles, has merely a well marked granular aspect.

132, 133, 134. Red corpuscles of the blood of the large green edible sea
turtle. Natural appearance. [Note. This sample of turtle blood was handed
me by Dr. Samuel A. Cartwright, who informed me it was from the Chelone
midas.]

135. The pallium vesiculatum (125, 126) made apparent in the red corpus-
cle of turtle blood.

136. White corpuscles in the turtle blood.

137. Red corpuscles of human blood, as seen when just drawn ; lenticular,
apparently structureless discs.

138. The same with the margin slightly crenulated, an appearance due to
to a slight contraction of the pallium (125) upon the nucleolar contents. This
appearance ensues spontaneously, and is probably due to exosmosis.

139. White corpuscles of human blood.

140. Red corpuscles of human blood, seen edge-wise, and packed together
like piles of coins — a spontaneous and almost constant occurrence, when no
agent has been mixed with the blood.

141. The stellated or mulberry form of the red corpuscles of human blood,
occurring spontaneously when the serum has been somewhat concentrated by
evaporation. Here the pallium has so contracted, as to adapt itself to every
protuberance and sinuosity of the nucleus, (vide 125) making the several nucle-
oli (a dozen or so) very apparent.

142. By treating human blood with weak tincture of iodine, or with bro-
mine, or with salt and afterwards vinegar, the pallium vesiculatum (125) as
here shown, is made apparent, presenting fine uniform granulations. Under
this treatment the nucleoli (141) not here represented, can also be distinctly
seen, without the contraction of the pallium, as in 141 .

Miscellaneous Medical Intelligence.

119

STRUCTURE OF RED CORPUSCLES OF BLOOD.

The conclusions which seem deducible from the foregoing, respecting the
structure of red corpuscles of blood, may be summed up and set down as fol-
lows :

1st. All red blood corpuscles, whose function it is to absorb oxygen for the
use of the animal system, whatever their diversities of size, shape and appear-
ance, in different animals, possess a similar, or at least an analogous struc-
ture.

2d. They all have & nucleus, or internal composite cell, similar in appear-
ance to other animal cells, and similar to algoid cells ; consisting of associated
smaller cells or nucleoli, held in an appropriate common envelope ; and these
smaller cells or nucleoli, containing again others still smaller.

3d. Around the whole nucleus is wrapped the distinctive tissue of the red
corpuscle, the pallium vesiculatum. In this is found the red coloring matter-
The function of this tissue is to absorb oxygen in respiration for the use of the
system. In its structure are multitudes of exceedingly minute spherical vesi-
cles of nearly uniform size. In the blood of man, etc., this pallium fits closely
upon the nucleus ; while in the blood of the Amphiuma, etc., the pallium forms
abroad margin around the nucleus.

SPENCER'S OBJECTIVES FOR MICROSCOPES.

The pre-eminent success of Charles A. Spencer, residing in Canastota,
Madison county, New York, in manufacturing objectives for microscopes, de-
serves a notice in this place. It is now fairly conceded that Spencer, though
an American, has considerably excelled the best English and European opti
cians in this most difficult department of practical optics. The American As-
sociation for the Advancement of Science have given him this award, and Eng-
lish microscopists have borne testimony to the same effect.

The preceding observations were made with a glass of exquisite workman-
ship, one of Spencer's latest and best productions. I gave him an order for
the finest objective of high power which he could make, expressly without
limit as to price. He sent me the instrument (the essential parts of which, the
smallest thimble would contain) in May, 1852, writing me at the same time
that it was the best he had ever made, and charging me for it, what I consider
a most moderate sum, $120 ; for its defining power is so great and so wonder-
fully accurate, that a sum of money greater than I choose to name, would not
deprive me of its possession. It is rated by Spencer as 1-1 6th of an inch
focus, though the available working focal distance is probably less than 1 -200th
of an inch, requiring the very thinnest of Chance's thin glass, for covering-
objects to be seen. Its angle of aperture is full 174° !— a figure at least 40
units beyond what the best European opticians have, until quite lately, consid-
ered practicable. Upon this, as well as upon the general perfection of work-
manship, its great excellence depends. That most difficult test object, the
Grammatophora subtilissima, of Bailey, is, by this glass, readily and clearly re*
solved into black beaded lines.

120 The New -Orleans Medical and Surgical Journal.

IX. — The rigid spirit — The South waking up — Prevalence of Typhoid Fever
in the country, etc., etc.

Pkattville, (Ala.) June 1st, 1852.

A Hester, M. D.

Dear Sir — I have been a reader and subscriber to your valuable Journa1
for the last four years, and I must say that I always hail with pleasure the time
of its arrival. I am truly glad the South is beginning to put forth her strength
to think and act for herself, and to show to the world, that while her re-
sources are developing she can exist independent of Europe or the North. I
am proud, sir, that we have now men in the South, and correspondents of, and
contributors to, the Journal, too, that are eminent as medical men throughout
the world. I hope that we will continue to be awake to our interest, and that
our march will still be onward.

Prattville, the site of my location, is a manufacturing village, with a popula-
tion of about one thousand, situated on Antauga creek, four miles from the
Alabama river, and fourteen from Montgomery.

Some fifteen years since the present site of Prattville was a perfect swamp,
about one mile North and South, and two miles East and West, until we come
to the Pine. The water is impregnated with iron and sulphur. The present
founder of the village, Mr. Daniel Pratt, has carried on a system of drainage
for the last five or six years that has made our village comparatively a dry one.
Some four years since we were scourged severely with Typhoid Fever from
June until September, since which time we have had comparatively few cases;
although through the summer and fall almost every disease is apt to assume
the typhoid type.

We have in the winter, as you would naturally suppose, from our situation,
Catarrhs, Pneumonia, Pleurisy, etc., and in the spring Diarrhoea and Dysen-
tery. We are just passing through an epidemic of Measles, the sequela? of
which has proved disastrous in many parts of the country. We have in this
location escaped well, considering the material we have to operate on. The
majority of the families among the factory operatives, when they first come,
are certainly the worst looking chances to live I ever saw ; they look as if
thev had been half starved, half clothed, and fed on dirt and snuff all their
lives; the majority of them are guilty of the filthy habit of dipping snuff;
and broken down constitutions to commence with. With all of these things
operating against us, we have only some four or five deaths out of about three
hundred cases. In a great many cases it has appeared almost impossible to
control the bowels ; in some cases the operations were very frequent, large
and watery ; the secretions appear locked up ; and calomel, even in the minut-
est dose, appears only to augment and increase the discharge. The only
thing I have been enabled to control it with is Opium and Acetas Plumbi. ;

Miscellaneous Medical Intelligence.

121

with injections of starch and laudanum; in other cases the discharges are on
the dysenteric order ; in such I have used hot fomentations, cloths wrung
out of hot vinegar to the bowels, with good effect ; Opium and Camphor,
Brandy, etc.

H. C. HILLHOUSE, M. D.

X. — [ADDENDUM
To Dr. Bowler s " Contributions" fyc. ; to follow page 72 of this

Journal.]

To refuse to publish facts because they will not be believed, was regarded
by Dr. Samuel Johnson as downright meanness and cowardice. The facts
related concerning the vivisection No. 1, upon the 6th of May, indicate re-
sults, (as clearly as experiments can do) which were as unexpected to me as
they can be to any person whatsoever. But I relate facts only, regardless of
their agreement or disagreement with received theories — regardless of my
inability to explain them so as to form a system. The honest upbraidings and
naive chidings of some of my correspondents, tend, in soeie degree, to make me
think that possibly I may deserve the compliment, though intended as a cen-
sure, conveyed in the following passage in a recent letter from a friend: "I
never could find what doctrine you want to establish— whether any or not." I
certainly never expected to establish the doctrine that an eviscerated animal,
having the spinal cord divided in the cervical and dorsal regions, and having,
also, the nerves cut away from all^s limbs, would still continue to manifest
both sensation and voluntary ration ! In former experiments, I had, with
one or two exceptions notice^, that although mere sections of the cord did not
destroy these fundament functions, yet complete longitudinal destruction of
that structure extinguished these phenomena almost instantly. The closing
experiments inN^-l? consisted of this complete but gradual destruction of the
cord, which tl^ animal was fully aware of, following, as it did with its feet,
the parts cfr'sentegrated ! Now, although it is unwarrantable to assume ana-
tomical structures in order to establish a doctrine upon a sure foundation, such
provisional assumptions are sometimes allowable as hypotheses, several of
^hich I suggest as possible explanations of the above mentioned experiments.
Taking for granted, as proved by decapitation, that sensation can exist inde-
pendently of the brain*,* taking for granted that the sensorium is diffused, nay,

* Sensation is no more the property of a special spot in the centre exclusively, than
vitality is. Parts of the human body, as noses, ears, fingers, and so on, after having
been separated from the general system for hours, have retained an independent vital-
ity and been re-united ; while, in other cases, particularly in Oriental countries, sur-
geons have restored lost parts in one person by taking parts from another.

122

The New-Orleans Medical and Surgical Journal,

even intensified in the periphery ; admitting, provisionally, that the muscles are
wholly devoid of sensation, still the spinal cord, though divided into segments,
appears essential to sensation and self-determined motion, How then can
these several spinal segments be connected with the periphery, in the absence
of the great nervous trunks which go to the limbs ? If we suppose the exist-
ence of anastomosing interlacements along the sides of the animal, originat-
ing with or implanted on the spinal nerves, and, perhaps, connected also with
the great sympathetic system, here will be a communication of a very general
character, though not visible to the naked eye. Jt is easy to decapitate ; but it
is not possible, in the short period to which a vivisection must be restricted, to
remove all the ganglions, plexuses, and branches of the sympathetic system —
a system that morbid action and vivisection prove to be endowed with sensation
— a system, in which each ganglion is regarded by Bichat and most other phy-
siologists as being a distinct centre. Hence, from the inextricable meshes of
this system, as well as from the spinal, countless numbers of nerves may per-
vade the substance of the muscles and become instruments of sensation, not-
withstanding the destruction of the great nerve trunks sent to the limbs.
Small portions of these nerves in the intervertebral foramina and a short dis-
tance beyond, were not removed. Hence, some branches may pass offlaterally
that would not be included in the plexuses.

The experiments ki No. 1, differed in manner from, and extended beyond,
former experiments, without contradicting them. But sciolists may exclaim
—what has all this to do with human physiology ? Are alligators like men ?
Not exactly. I have acknowledged the difference upon former occasions, per-
haps to an unwarrantable extent.* I have a better right to the benefit of the
objection than these gentlemen, because they profess to follow the celebrated
Carpenter, Todd, Bowman, Hall, and others, who, in their latest and most ela-
borate works, insist that the cold-blooded annals are the most reliable ones
for physiological experiments : Messrs. Todd and Bowman, in their most ex-
cellent work, now in the course of publication, namely, " Physiological Anat-
omy and Physiology of Man," say " That the nervouz force endures much
longer in the cold-blooded animals''' — " On this account the cold-blooded animals
must be selected for exhibiting the phenomena" — a proposition which Prof. Car-
penter iterates and re-iterates, particularly in his learned work, " Physiology
General and Comparative," just republished in this country. Now, if dissent-

* A foreign critic, in 1847, who intended to do me all possible damage, speaks qa
this wise : "Can any one, we ask, entertain a doubt that, the conditions being the
same, the consequences would be the same in man, with a spinal centre constructed
upon essentially similar principles to that of reptiles and animals ? If such kind of
evidence be rejected, physiology must return to its very infancy, for, with few excep-
tions, little or nothing can be learnt, strange as it may sound to some ears, of human
physiology from observations restricted exclusively to man." A Dutch Governor
tried to please all, but finding that impossible, determined to hear only one side of
every case, as he found that hearing both sides not only confused his mind, but gave
the trouble of changing the first opinion and forming a new one !

Miscellaneous Medical Intelligence.

12S

ing gentlemen were more consistent in their objections, their logic would be
none the worse for their philosophical reputation. If they can believe that
European frogs and turtles illustrate human physiology, why should they re-
ject the Crocodilus Mississippiensis, albeit, the wisest, biggest, and most per-
fect beast of the cold-blooded class, as the physiologists of the old world have
the justice to acknowledge ? Does the original curse against reptilians apply
to the alligator only, so as to render it unfit for physiological experiments ? It
is evident that it was not the reptile which deceived Eve ; for it does not " go
upon its belly all the days of its life." It walks on four legs ! The curse that
clings to it is that of being a native American and not a European i Verily
an Alligator ik hath no honor in his own country,"* although anatomically and
physiologically he combines to a greater extent than any other single animal
the essential types characterizing the vertebrata and aiticulata, approaching
birds and mammals on the one side, and rising above the fishes, worm* and
mollusks on the other. Can the resistance-men prove that crocodiliai diges-
tion, absorption, sanguification, nutrition, secretion,circulation, voliti^,motion,
hearing, seeing and feeling, are altogether different in nature, nn: simply in
degree, from those functions in man ? Take the strongest example of con-
trast, namely, the tenacity of life in the saurian: because life persists longer
in the latter than in the former, after extensive injuries, does11 follow that the
vital actions of the one are essentially different in nature *s well as in degree
from the other ?

Can any unprejudiced and enlightened mind, upon careful review of the
above mentioned experiments, and many others whi'h I have made and pub-
lished, reconcile them with the following statements ? — statements founded
almost entirely upon Sir C. Bell's experiments — vhich experiments Bell said
were but very few, and even these few he had n> confidence in, as he emphati-
cally declares ! Todd and Bowman say : " Tie anterior root of each spinal
nerve is motor— the posterior sensitive. T*e irritation of the latter gives rise
to no muscular action. Comparative anateny confirms this conclusion among
all classes of vertebrate animals. The ^rigin of a double root denotes a dou-
ble function. The union of the encheplalon with the spinal cord is necessary
for voluntary motion and for sensation"

* Have the anti-croeodilians fors°t that the classical history of this Reptilian is
most honorable? That it was <ne symbol or hieroglyphical representative of the
mighty Typhon, the slayer of 'lie famous god Osiris, who was the brother and hus-
band of Isis, and father of the " ever living, resplendent Horns, the beneficent deity?"
At the city of crocodiles, Arsinoe, this sacred saurian was worshipped the most de-
voutly, whether living or dead, in the days of the Pharaohs.

124 The New-Orleans Medical aud Surgical Journal.

XI. — AN ANALYTICAL REPORT OF THE MISS. STATE HOSPITAL,

FOR THE QUARTER ENDING 31st MARCH, 1852.

Discharge in

DISEASES

— ~p

PLACE OF NATIVITY.

Acute Bronchitis,

Ireland, 31

Abscess, - - - -

a
u

Germany, 4

Ascites, -

England, 4

Burns, -

n
U

A
V

1
1

France, - 1

t-^mtusions, -

Switzerland, - - 1

Diairhoea, -

United States, - - 16

Dysentery,

A
U

i
i

Debility ....

Q
O

Erysipel^, .

RE CAPITULATION.

Fever, Intermittent, -

c
0

" Typioid,

Remaining, Jan. 1st. 1852, 11

" Mixea, _ .

Admitted this quarter 57

Fracture, Clavuie,

Discharged - - 52

Died ... 7

Inflammation, Gasric,

Rprrm inino* Anril 1 <i IRS^ Q

" Knee^pint,

A
U

Opthalmia, \

a
U

C. S. Magoun, m. d.,

Mania a Potu, - -N .

A
U

Physiciun &. S uvgeon.

Pneumonia, - - N

n
u

Syphilis, - - - \.

q
d

c
0

Ulcer, -

Total - - -\

IJ LUiiJ Ui

Acute Bronchitis,

Burns, -

t>\

Dropsy, ....

Diarrhoea, -

Laryngitis, ...

Dysentery, -

Pneumonia, ...

°-

Total

1 5

i 7

XII. — Orc Urinary Calculus.

BY PROF. EVE.

The June No. for 1852 of the Nashville Medical Journal, reports a number
(25) of interesting cases of Lithotomy performed by Prof. Eve of the Univer-
sity of that place. We have only space for the " Recapitulation of the 25
Cases"

Sex. — 23 were males and 2 females.

Race.— 2 were black, 2 mulattoes, and 21 white.

Miscellaneous Medical Intelligence.

125

Age. — 16 were under thirteen years, 7 between twenty and thirty-five, 1 at
sixty-five, and 1 at seventy-seven.

Operation. — Twenty-four were cut, twenty-three of which by the double li-

thome.

Result. — 4 died after being operated upon, 3 of which from the operation, 2
indirectly, (supervention of erysipelas) and only one directly from it (superven-
tion of erysipelas). The remaining 21 fully recovered. Of the 19 first opera-
ted upon, but one died ; and in that instance death was not owing to lithotomy.
17 were well in two weeks after the bi-lateral operation. In no case have I
heard of the reproduction of stone, nor has a fistula occurred in one.

Number of Calculi and their Chemical Constituents. — Single in twenty-two
cases, 2 in one case, 3 in another, and 117 in another; total, 144 stones in
twenty-five cases. Composition, chiefly some preparation of lime. There is
not the usual proportion of uric acid formation. Of the five specimens ob-
tained in Tennessee, each contained lime ; thus confirming Professor Peters'
analysis of the Dudlean collection of calculus at Lexington, Ky. It would
seem from this collection that phosphate of lime is not as rare a composition of
urinary concretions as is generally supposed.

My method of performing lithotomy is now submitted, but claiming for it
nothing original.

It will be seen that decided preference is given to the bi-lateral operation of
the late distinguished French surgeon, Dupuytren. I have found, that owing
to the irregularity of the external surface operated upon, it was difficult to
make the crescent-like shape, or the semi-circular incision, through the skin
and soft parts. I now make the cut like a ^, with a short tail. The grooved
staff previously introduced into the bladder, and the scrotum elevated by an
assistant; a short incision is made directly upon the raphe of the perineum at
the bulb of the urethra, and the direction changed at a very oblique angle at
the end of about three quarters of an inch, to terminate at a point midway be-
tween the anus and left tuberosity of the ischium. With the edge of the knife
now turned upwards, it is made to penetrate and commence the other leg of
the ]^ at the point of the right side corresponding to the one just terminated
upon the left. This incision is deepened as the instrument ascends, and arri-
ving at the middle of the perineum with the edge turned directly upwards, the
urethra is opened, and the groove of the staff exposed. This not only simpli-
fies the external incision of lithotomy, but effectually guards against the liabil-
ity to wound the rectum. The operation is then completed in the usual
manner.

The suggestions made in the Southern Medical and Southern Journal, in
1849, in regard to the instruments, I expect to have carried out this summer
while in Paris, and they may hereafter be presented to the profession.

Note. — Professor Eve is now in Europe, we believe, collecting a museum
and obtaining the necessary materiel for illustrating the Lectures in the Uni-
versity of Nashville. (Ed.)

126 The New-Orleans Medical and Surgical Journal.

8l)e 3f*m-©rkans judical anir Surgical Journal.

Vol. IX.] NEW-ORLEANS, JULY 1, 1852. [No. 1.

Until about the middle of May, the health of the city continued quite good ;
but at this time the list of deaths began sensibly to increase, as will appear
from the annexed statement —

DEATHS IN THE CITY OF NEW ORLEANS

For the 9 tueeks ending June 1852.

1852

Cholera.

Fevers.

Total.

April 17th,

142

" 24th,

123

May 1st,

137

<: 8th,

138

" 15th,

161

" 22d,

171

29th,

178

342

June 5th,

179

342

" 12th:

129

299

Total,

552

119

1855

Of which number died under 10 years of age 718, and 248 colored.

From a glance at the figures above, we perceive that for the week ending
May 15th, the deaths by Cholera counted seventeen, and from this date the
deaths increased so rapidly, that at the end of the following week they num-
bered one hundred and seventy-eight ! At about this point they remained sta-
tionary, both as regards Cholera and the totals, for about two weeks, when both
the Cholera and the totals began rapidly to decline, and we have no doubt that
when this reaches our subscribers, the disease will have nearly disappeared
from the city.

Infection played no part this time in the propagation of this disease over the
city; it sprang up at a time when the weather was not unusually hot for the
season, and after we had reached the middle of a long dry season. During the
prevalence of the disease, we had some heavy and refreshing showers ; but the
Cholera was neither checked nor aggravated thereby. Surely this is a disease

sui generis it is not amenable to any of the known laws which usually govern

the development and course of epidemics ; it breaks out in dry, and ceases not
its ravages amid daily showers and the explosion of electricity. It must be
either above, or it creates its own laws de novo, and as yet we remain ignorant
of their nature. By some it was thought that fruit and vegetables, unusually
abundant this season, proved the immediately exciting cause of the disease; but
we are satisfied that this is not correct, not only because many have fallen vic-
tims to the disease who avoided most scrupulously fruits and vegetables of

Editorial.— City, IntelUgetie.e.

121

every kind—but also because the disease is already rapidly declining, when out
markets are loaded with fruits and vegetables of all descriptions, and much
cheaper than earlier in the season. If he is happy who can know the cause of
things, thrice happy would he be who could reveal the cause of Cholera, and
thus perhaps place it in the power of man to shield himself from its ravages.

The disease, as recently witnessed, differed in some particulars from previous-
attacks — thus, the premonitory diarrhoea persisted longer before the stage of
collapse supervened ; the cramps were less frequent, although quite obstinate
in some subjects. In one particular we found but little difference, namely, the
fatal tendency of the disease after the patient reached the collapsed stage. The
violent cramps may be promptly relieved and kept subdued by the inhalation of
Chloroform. Frictions with pounded ice have aided in bringing about reaction*
in some apparently hopeless cases; but it is difficult to say whether nature o*?
the remedy saves such patients. Let us, however, do our duty in such cases,
and trust the issue to God.

At the time of going to press, the health of the city is rapidly improving,
and we confidently anticipate entire exemption from the disease in a few weeks,

CORONER'S INQUEST.

The loose and too often careless manner in which inquests have been held in
this city, has frequently excited remark, and occasionally provoked the ridicule
of some of our daily prints. Whilst, by consolidation, we have sought to re-
form many abuses, and to curtail the expenses of the city government we are
not a little surprised that those who advocate economy and a faithful perform-
ance of official duty, have not turned' their eyes to the enormous profits accru-
ing from Coroner's Inquest. We beg to state, in limine, that we deprecate any
intention to reflect upon the integrity and motives of the present incumbent ;
that functionary but travels in the footsteps of those who have preceded him for
years, and performs the duties of the office v/ith equal ability and punctuality.

The fees of the Coroner are too high, and it is generally believed that In-
quests are often held in cases where the necessity for an inquisition does not
exist. For this we do nGt undertake to censure our highly respectable Coro-
ner ; the fees are fixed by law, and like most of us, he charges all that the law
allows. The Chief Justice of the Supreme Court receives about one half the
pay that accrues from Coroner's Inquest in this city. To discharge the high
and responsible duties of the first station, the highest legal attainments are re-
quisite ; whereas, the people seem to think any ordinary individual of respect-
able standing is competent to act as Coroner. Now we maintain, with many
others, that a medical man is alone competent to perform the duties of Coroner;
indeed, in all the large cities, both of this country and Europe, none other than
a Physician of attainments is ever nut forward for this office.

128 The New-Orleans Medical and Surgical Journal.

To restrict Coroner's Inquests to their legitimate subjects, a fixed salary—
a stipulated sum should be paid over to that functionary, and that too without
regard to the number that may be held in a given time. In the late proceedings
of our City Council, we saw it stated that our Coroner had received for In-
quests for a single month seven hundred and fifty dollars. This would amount
to the handsome sum of about nine thousand dollars per annum; a pretty
snug job for a hasty inspection of those who die by violence, by drowning, etc-
We venture to assert that there are in this city a number of well-qualified
medical men, any one of whom would cheerfully undertake to perform the du-
ties of Coroner for the entire city for $2000 or $2500 per annum. Let our
citizens look into this matter, and in the meantime we shall have more to say
on the subject.

UNIVERSITY OF LOUISIANA—MEDICAL DEPARTMENT.

We direct attention to the circular of the Medical Department of the Uni-
versity of Louisiana, to be found at the close of this number. The Dean of
the Faculty, Prof. Hunt, has set forth the advantages of this city for the acqui-
sition of a practical medical education in their true light ; and we therefore
refer the student to his circular. We really believe that no city of the Union
presents superior advantages to that of New Orleans for the thorough education
of the medical student. The great Charity Hospital, into which are admitted
annually from eighteen to twenty thousand patients, is thrown open to the faculty
and the students, during the course of lectures ; and if those who walk the
wards of this institution do not make themselves familiar with disease, it is not
for want of the necessary facilities. Read the circular and judge for yourself.

MEMPHIS MEDICAL COLLEGE.

Memphis is a growing city, and the citizens of that town have resolved to
build up a medical school equal to any in the great West. They have already
completed a fine building — endowed and put into operation a commodious Hos-
pital— organized a full Faculty of Medicine — and during the last season re-
ceived over one hundred and twenty-five students. It is an accessible point
at all seasons of the year ; and from its locality and the talents of the Profes-
sors, we predict a prosperous career to this new school of medicine. For par-
ticulars, we refer to the advertisement of the Dean, Dr. Shanks, in the commer-
cial department of the Journal.

Editorial. — City Intelligence,

129

CASE OF DOUBLE UTERUS WITH OCCLUSION OF ONE SIDE—
THE PATHOLOGICAL RESULTS IT GAVE RISE TO—DEATH AND
POST MORTEM.

By D. Macgibbon, M. D., Visiting Physician to the N. Orleans Charity Hospital'

(Accompanied with a Lithographic View.)

The following case of congenital malformation of the Uterus is sufficiently interest-
ing to be placed on record. It occurred in the person of the young woman, a clinical
history of whose case I gave in the New Orleans Medical and Surgical Journal of
March last

Since that report was written, the woman has again been under my care in the
Charity Hospital, where she died on the 9th of May ; and if the previous history of
her disease interested me, the real condition of the parts implicated disclosed at the
post mortem, serves to enhance that interest in no slight degree.

But before giving the results of that examination, let me here briefly recapitulate
some of the more prominent points in the history referred to, and which are deemed
necessary to the better understanding of the case ; as well as to add a few more,
which will bring that down to its close.

Johanna M., a servant girl and unmarried, was in the enjoyment of good health
until a short time subsequent to the pubertatic epoch, which established itself at the
usual period, when she noticed a large tumor in the vagina, which projected some-
what. Its formation had not been accompanied with any painful feeling : its only
annoyance being a sense of dragging in the lower part of the belly, when she moved
about ; and a feeling of fulness there, as well as in the vagina. After the appear-
ance of this tumor, the menses, which had been regular, ceased, and remained away
six months, when they again returned : with that the above annoyances were in-
creased ; and shooting pains followed, which became ultimately so severe as to force
her to the Hospital for relief.

It will be recollected that she entered that institution on the 17th of June, 1851,
nearly twelve months after the tumour first appeared. At this time it presented it-
self to view between the labia?, and was found to have the anterior wall of the vagina
for its covering ; it fluctuated, and was tapped, giving exit to about a pint and a half
of dark, ropy fluid. Besides this, on entrance, as will be seen from the published
report, " in the uterine region, a ridge-shaped tumor could be readily felt, through
the abdominal parieties, extending from the symphysis pubis upwards, to within
two inches of the umbilicus ; and in the left iliac fossa a large irregular tumor
could be felt in the same way ; this, seemingly, was connected with the former. . .
The lower part of the abdomen, when measured by a line taken from the umbilicus
to either of the superior spinous processes of the ilium, was demonstrated to be fully
an inch larger on the left than on the right side." (Page 678.)

" Hysteritis and overitis" set in twice during her stay in the Hospital, and were
subdued by appropriate treatment. The vaginal eac refilled, and was tapped in all
four different times. Her general health became restored, and she left on the 22d
September following.

She had not while in the house any return of her menses. But these returned
shortly after going out ; and with that the sac in the vagina became again distended

130

The New-Orleans Medical and Surgical Journal.

with fluid, and burst of its own accord, at the old cicatrice, at the close of the year,
by which she obtained great relief. With the exception of a slight interval, she was
enabled during this period to follow her former occupation, at which she continued
till the end of January, 1852, when a violent return of some of her old symptoms
sent her back to the Hospital which she entered on the 6th of February.

From this point the unpublished portion of the clinical history of the case remains
to be taken up, and that will now be done, and very briefly.

Acute inflammatory action occurred anew in the uterine region, and, this time,
spread over the peritoneal covering of the rest of the abdomen.

She did not menstruate again after she entered the Hospital ; nor did the sac again
refill; the artificial opening to this remained in a fistulous condition, and a discharge,
with an exceedingly bad odor, constantly drained away from it.

The more violent symptoms of peritonitis were subdued by appropriate means ;
but for some time, after this, there still remained some chronic inflammation, especi-
ally in the hypogastrium. The tumor in the left iliac fossa was observed gradually
to subside, till latterly it all but disappeared.

The following note of her case, taken from my note-book, made on the 7th April,
will perhaps serve best to show the condition at this time of the diseased parts ; it ..
was the first digital examination, as well as the last, which I was permitted to make
during this occasion. " This morning made an examination per vaginum The pas-
sage tender ; when the finger was being introduced, complained much of pain. The
old sac, connected with the anterior wall, still there, but very little distended. The
os uteri easily got at ; firm and small (normal) to the feel. The body of uterus felt
larger than natural ; when the abdomen over it was pressed upon, this did not seem
to be moved in any obvious degree ; but when the left ovarian region was pressed
upon, in a slanting direction towards the centre, there seemed to be some motion im-
parted to the body, or that portion of it adjoining the cervix uteri on the same side ;
a good deal of pain was complained of when the finger was made to push against the
uterus. The whole passage and uterine organs seem to be highly irritable ; no in-
creased heat noticed."

Her treatment now was palliative. She never recruited ; ceased to take her food
well; became ansemic, and finally symptomatic irritation, producing vomitiug and
diarrhoea, came on, and this, together with the constant drain of purulent matter,
soon hopelessly exhausted her. She expired, as already mentioned, on the 9th of
May. The body I examined twenty hours after death, and will now proceed to give
the main results obtained.

Opening the abdomen exposed several bands of adhesions in different portions of
that cavity. The peritoneum lining the different parts within the pelvis, was black
and sloughy looking. Several of the parts here were torn on the slightest freedom
being made. The most important alterations of structure were found on the left
side. The ovarium was in part destroyed, as if by suppuration ; and a considerable
cyst, connected with it, was found in a nearly empty state ; from the rugged condi-
tion of its walls at several points, as well as adhesions it had formed with adjacent pe-
ritoneum, it was pretty evident that it had burst at some previous period ; most pro-
bably when she last entered, giving rise to peritonitis. The Fallopian tube was
turned forward on itself, and was retained in this position by an adventitious band,
which connected it, by a point, at its fimbrated extremity, to the left fundus of the
bladder ; while its open canal, greatly distended up to the point of flexion, was con-

Editorial. — City Intelligence.

131

nected with the aforesaid cyst, of which, it may be said, it was made to form a part ;
its inner surface, as well as the same in the cyst, had a dark, melanotic-like appear"
ance, showing that the contents, which had discolored the latter, had been also in
contact with the former, and suggested the channel by which these had escaped from
the cyst, and finally out of the body. The other half of the Fallopian tube, namely,
that which connected it with the uterus, was of normal calibre, barely permitting of a
small silver probe to pass it.

The right ovarium was small and soft ; and here, as on the other side, there were
considerable traces of chronic inflammation in the peritoneum to be seen. The ute-
rus was larger than the unimpregnated usually is ; but further than this, and the
changes noticed in its peritoneal covering, it presented nothing externally by which
to distinguish it from the normal virgin uterus. (See note and fig.)

Removing it and its appendages from the body, the vagina was next laid open, and
the connection of its sac with the parts superior endeavored to be traced. A probe
introduced into the fistulous opening, found an inch above the meatus urinarius, to
my astonishment, passed readily up into the fundus of the uterus : another, introdu-
ced by the os uteri to the same quarter, could not be made to come into direct contact
with the former. The cause of these anomalies was explained by laying the uterus
open, when it was ascertained that this was divided by a longitudinal septum, com-
posed, to all appearance, of the same tissue as the uterus itself, into two distinct and
nearly equal cavities ; the right having the os uteri as its natural outlet, the left
being furnished with none such, but made to communicate with the sac in the va-
gina, which, indeed, seemed an extention of it, both having the same mucus lining.
The color of the interior of the sac, as well as the uterine cavity connected there-
with, partook of the same darkened hue as that observed in the ovarium cyst and
expanded portion of the Fallopian tube. The color of the right cavity of the uterus
was different, being that of the healthy organ.

The r ugce of the vaginal canal, especially in the neighborhood of the fistulous
opening, were much excoriated. The os uteri, however, was healthy.

No other disease of any consequence was found in the contents of the abdominal
cavity. The chest was also examined, and no disease found there. I was therefore
correct in the conclusion I came to at the outset of her disease, " that there was
nothing of a malignant character about it." It will be seen also that I was correct in
my early diagnosis of the vaginal tumor, " that it was in some way dependent on the
diseased condition of the parts occupying the uterine and left ovarian regions," and
not simply a pelvic cyst, as some supposed.

The manner in which the uterus was involved continued confessedly obscure ;
though from the earlier diagnosis quoted of the ridge-shaped tumor occupying the
left uterine region (no doubt from the distention of the fluid commencing in the middle
of the uterus and confined to the left side), as well as that made at a later period and
quoted above, it was rendered pretty evident that it was the left portion of that organ
which was especially implicated. It remained for the post mortem, by disclosing the
double character of the uterus and occlusion of the left side, to clear up, as it com-
pletely did, what otherwise was obscure in the history and symptoms of this extraor-
dinary case.

The intelligent reader will, on a review of all the facts furnished, readily understand
how a female with this malformation should get along well enough till the change at
puberty established itself ; after which, and while the menstrual fluid secreted in the

132 The New-Orleans Medical and Surgical Journal.

right side continued to flow regular at each monthly period, he can see how that
which was secreted in the left, which was occluded, being retained, should occa-
sion distention, which would, while her periods remained regular, go on increasing.

It is difficult to say whether the shut sac originally terminated on a line with the
neck of the uterus, and ultimately extended itself down, by the augmenting pressure
of the contained fluid causing the parieties to give way at this their weakest point,
into the vagina, where it was latterly found ; or whether this extension existed as a
congenital formation ; but, be that as it may, it is certain that the accumulation of
the fluid up to a certain point, occasioned but little annoyance ; having, however,
once reached that point, further enlargement of the vaginal sac became more diffi-
cult, and therefore more painful. Continued distention led to irritation in this and
the left side of the uterus, which was communicated to the ovaria of the same side ;
and this again to the inflammatory action which prevailed when she first entered the
Hospital ; and which, as we saw, was more especially confined to the left side of the
uterus, and its appendages. He will also easily perceive how difficult it was to con-
clude in this case that the vaginal sac, as well as the other ailments, were caused, as
the sequel proved, by retained menses, with the woman menstruating regularly when
the first of these made its appearance ; and indeed a considerable part of the time
since up to her admittance to the Hospital.

Again,he will understand how, after the treatment followed to relieve her, and espe-
cially the menses remaining away, the woman's health should be so far established
as to leave the Hospital and resume her former occupation as she did. Further, he
will see how a restoration to perfect health and the return of the catamenia, which
occurred on her leaving the Hospital, should bring on a recurrence of all her former
annoyances, as it shortly did. The dark color of the fluid which came from the va-
ginal sac, when it burst at this period, and which resembled that which came away
shortly after she entered the Hospital first, when I tapped it, leaves little reason to
doubt but that it was retained menses. It differed much from that which was ob-
tained from the same on two intervening occasions, when her menses were absent some
tune, which was, it will be recollected, yellow and gelatinous looking, and was proba-
bly secreted by the inner walls of the sac. From all of which it will appear evident
that the peculiar character of the malformation of the uterus was the immediate
cause of all her ailments. Indeed in this case greatest safety would seem to have
consisted in that deranged state of health where the menses remained suppressed ;
while complete restoration to health, as we have seen, contrary to what is usaal,proved
her bane. Whether in a similar case, supposing its nature to be known, any surgical
operation at the outset, by which free vent would be secured for the secretions of the
occluded half of the uterus, would prevent like distressing results with those above
recorded, remains to be proved. But cases of this kind are so exceedingly rare, that
one may never have an opportunity of meeting with another. A few are recorded
where the septum was partial. One of this kind, the latest I have noticed, is copied
in the British and Foreign Med. and Chir. Review for April, 1649, and here it so little
interfered with the ordinary function that the woman had children several times, and
twins once. But, at present, I do not recollect to have noticed any, where the septum
was complete with occlusion of one side, as in the one I have recordod above ♦ and
where also similar pathological changes resulted from it : though I have little doubt
some such have been met with ; and some of these recorded also.

Note, — The accompanying Figure represents the posterior of a double uterus, with

Editorial — City Itelligence.. 133

the vagina laid open from behind. From the sketch having been inadvertently trans,
ferred to stone without being reversed, the impression exhibits the right left, and left
right ; this requires to be recollected.

A, Meatus Urinarius. B, Vaginal Sac. C, Left Cavity of Uterus. A probe
introduced into the fistulous opening, is seen traversing these. D, Os Uteri. E, Right
Cavity of Uterus. The longitudinal septum is not attempted to be shown.

OUR ORIGINAL CONTRIBUTIONS.

This number will be found rich, both in the variety and ability with which
the original articles are written. They occupy nearly 80 pages of the Journal,
and will be read, we feel satisfied, with much interest by our subscribers.

The first article, " On the use of Quinine in Continued Fever" by Dr. Wm.
M. Boling, of Montgomery, Alabama, is elaborated with all that precision and
accuracy so characteristic of the distinguished author. Dr. Boling is opposed
to Quinine in Continued Fever, and contends that, whether given in large or
small doses, it fails to arrest the fever. He deals some terrible blows among
those who advocate doctrines adverse to his views. He has tested the Quinine
practice and finis it a failure. In the course of his remarks he does not forget
to inflict some gentle strictures upon the views of our vis a vis confrere — Dr.
Fenner, who contends that Quinine, if properly given, in the forming stage of
fevers, will cut them short.

The second article, " On the present Hygienic condition of California" etc.,
by Dr. Thomas M. Logan, is prepared with that regard to elegant composition
and finish of diction, seldom witnessed in the productions of medical practi-
tioners. Dr. L. is a finished scholar, and is as familiar with the works of
Addison, Steel, etc., as he is with those of Sydenham, Pringle, Rush, and others
of like renown. His style has all the attractiveness of Bulwer's or James', but
at the same time, he imparts the soundest medical doctrines, and proves himself
an astute observer and a sound practitioner. Dr. Logan's contributions to me-
dical literature have already secured him a well deserved and a wide-spread re-
putation.

The third paper, on the " Mortuary Statistics of Memphis, Tennessee, for
1851," by Prof. Shanks, is a reliable paper, and contains much interesting infor-
mation in relation to the sanitary condition of Memphis. Prof. Shanks, we
need scarcely tell our readers, is a gentleman of great ability, and has already
acquired a high standing in the profession, by his contributions to medical and
statistical science.

Article fourth, " On a Case of Gun-shot Wound," by Dr. Massie of Texas,
displays at once the scholar and the scientific surgeon. To Dr. Massie's skill
the patient was indebted for his life. His case is highly creditable to American

134 The New-Orleans Medical and Surgical Journal.

surgery, and will have an important bearing upon the treatment of gun-shot
wounds.

The fifth article, by Dr. Magoun, on " Natchez as a winter resort for Con-
sumptive Invalids" is calculated to produce a favorable impression abroad, and
to invite consumptives to that high and salubrious city for the resto^ition of
health. According to the statement of Dr. Magoun. Natchez is unquestionable
the most desirable place in the South for consumptive subjects. His argu-
ments and statistical information may be relied upon.

The " Clinical Notes from Private Practice" \s the sixth article, by Doctor
Scruggs of Louisiana. These notes indicate the sound and reflecting prac-
titioner, and the quick and ready observer. They abound in professional epi-
sodes, and will do much good in the profession. Read them attentively.

The seventh article, on " The Yellow Fevev, at Houston, Texas," by Doctor
Massie, without claiming any thing original, is yet full of valuable suggestions
and historical incidents.

Article eight, " On the Motive Power of the Blood," by Dr. Ely, is a master-
piece of logic and severe analysis. He utterly demolishes the so-called "Wil-
lardian theory," and leaves scarcely a wreck behind; If any enthusiast can
command the moral courage hereafter to uphold this " vision of the brain," he
will be compelled to rest his postulate upon a sandy foundation. Dr. Ely has
ended the farce, and why not let the curtain drop upon the scene of strife for
ever? His paper is a model for argument, and that scathing criticism which
many may strive to imitate, but few indeed can excel. Let every one
read it.

Article ninth, " On the Cholera as it appeared in California " by Dr. Taylor
of Alabama, gives a distressing picture of the hardships and sufferings of emi-
grants, when crowded together on board vessels in search of El Dorado.
Much credit is due the Doctor for his exertions in behalf of his fellow-pas-
sengers, under the most trying and alarming circumstances. Such conduct
indeed ennobles the profession, and justified the Roman orator when he ex-
claimed that " a humane and rational Physician was equal to the gods."

Article tenth, on " Contributions to Experimental Physiology," by Doctor
Bennet Dowler, stands alone for its originality, raciness and bold declarations.
Dr. Dowler asserts nothing that he cannot reveal by the knife ; he kneels be-
fore the great temple of the living God, and with scalpel in hand, carves his
way into the sanctum sanctorum. He relies upon no guide — he has no Mentor
but Nature — no genius but that of inspiration, and no object but that of truth.
Dr. Dowler has dealt out some heavy blows against the theories first enunciated
by Sir Charles Bell and Mr. Hall, and subsequently upheld by a host of British
and American writers. Unterrified by the " stat nominis umbra," by the sha-
dow of great names, he has pushed his physiological inquiries far beyond his
predecessors, and is now upon the very threshold of that world of light, which
is destined to burst upon and astonish the scientific world. Let no cowardly
criticism seek to deter him from his high mission. Dr. D.'s paper will bear a
careful perusal.

Editorial. — City Intelligence,

135

Article eleventh) on " Probing the Fallopian Tubes" by Dr. Cartwright, is
intended as a rejoinder to certain critical observations on " Catheterism of the
Fallopian tubes," as published some time since by Dr. C. in this Journal. The
Doctor is exceedingly caustic in his reply, and argues in favor of the practica-
bility of.the operation under certain morbid conditions of those tubes. He is
a pleasing writer, and as a debater on disputed medical questions, a most astute
and formidable antagonist. Dr. C. is not easily driven from the field of con-
troversy; and if modern writers fail him, he appeals at once to those who wrote
in Greek, Latin and Hebrew — thus overwhelming his assailants by his immense
biblical knowledge.

Let no critique then attack the Doctor, without first counting the cost. He
wields the club of Hercules, and never lifts it but to fell his opponent to the
earth.

With these hurried remarks we dismiss our contributors, and again thank
them for the pleasure and instruction we have derived from a perusal of their
several papers.

KOUSSO ON THE TAPE-WORM.

A. Hester, M. D.

Dear Sir — In compliance with a promise made you some time since, I now
give you the result of my experience with the new remedy for Tape- worm—
Kousso. I have used it in two cases only, which I will relate as briefly as pos-
sible.

The first was a young gentleman, about the age of twenty-one years, a resi-
dent of this city. He had suffered from it from childhood, and had been treated
for it by a number of Physicians, both in England and in this country, previ-
ous to my acquaintance with him. He states that no treatment heretofore used
had afforded him any but partial relief, and at last would mitigate his suffering
only for a few days. The entire catalogue of Anthelmentics had been tho-
roughly tried in his case, particularly the Terebinthinate preparations, and
pushed to an extent in several instances to seriously affect his general health,
and as he states, in one or two, to endanger his life ; still the animal was not
destroyed and his sufferings continued.

I have treated him for the last three years, at intervals, with varied results,
but invariably gave him some relief for a time ; at times he would discharge
from a few separate joints to several hundred ; at others, portions of the worm
measuring in length from three or four inches to seventy or eighty feet ; and
I may here state, that since I commenced treating him, he has discharged over
a thousand feet of worm.

Tn February last it annoyed him very much, and I determined to try the
Kousso on him ; accordingly, half an ounce was administered in water at bed-

130 The New-Orleans Medical and Surgical Journal.

time, followed in the morning by a seidlitz powder. In a few hours his bowels
were moved, but no signs of worm or the Kousso could be discovered in the
evacuations. During the following night the Kousso came away, bringing
with it a large quantity of the worm, broken, and torn, and mangled to such a
degree, that it was some time before it could be recognized in the mass of mat-
ter. Such portions as could be selected from the mass, of sufficient size and
form, worthy of preservation, can be seen at my office, with specimens of en-
tire worm from the same person.

With a view of making it as certain as possible, and to give it a full trial,
after the lapse of a week the dose was repeated ; but this time it was premised
by a dose of castor oil, for the purpose of emptying the bowels, so as to give
the remedy entire control of the alimentary canal, and to encounter nothing
but the animal itself; but no traces of worm could be observed in the opera-
tions of the bowels ; nor since the operation of the first dose. The young
man is positive that the animal has been entirely destroyed.

The other and last case was also a resident of this city, a lady, about 35
years of age. She had passed portions of worm tor fifteen or eighteen years.
She suffered greatly from indigestion, derangement of the bowels, menses, etc.,
mostly all her life.

A half ounce of Kousso was given her about the first of March last, which
brought away a large amount of worm, broken up as in the former case. In
this case no cathartic medicine was given either before or subsequent to the
administration of the Kousso.

Her digestion has since greatly improved ; her bowels and menses have be-
come regular ; and she has gained considerable flesh and color ; in a word, her
general health has greatly improved. She states she never was as well in her
life before. So far she has had no return of the symptoms of the worm, and be-
lieves she is entirely relieved.

I am not prepared to give a decided opinion as regards the action of the
Kousso upon the worm ; but you will readily infer from the foregoing (the ap-
pearance of the worm as brought away by the remedy) that I am inclined to
the opinion that it acts mechanically upon it ; analogous to the Dolichos Pru-
riens on the Lumbricoides.

Upon reflecting on this method, after having made the promise, I came to the
conclusion to defer this communication longer than was originally intended,
for the reason that I wished some time to elapse, to see whether there would
be a return of it in either of the cases, as I desired to give a statement that
could, to some extent, be relied on.

Although several months have elapsed since the medicine was given, and no
symptoms of the existence of the worm have reappeared, still I am not yet
satisfied that they will not return. Should they return in either case, 1 will
advise you of it.

In conclusion, I would say that although not certain that this article will or
can entirely eradicate the worm, and drive it from the system, I am satisfied

Editorial. — City Intelligence.

137

that it is the most effective remedy I have ever tried in its removal, and I have
used all the remedies I ever heard of, and have treated a good many persons
suffering from Tape-worm. I would further add, that there is no danger in
using it whatever ; no unpleasant symptoms occurred in either of the cases ;
and did not even disqualify them for their ordinary pursuits.
Very respectfully, yours, etc.,

J. A. FRYDINGER, M. D.

New Orleans, June 20, 1852.

THE MINERAL ACIDS IN CHOLERA

We feel it our duty as editor, to call the attention of the profession to the
efficacy of the mineral acids in the treatment of Cholera. From time to time,
we have noticed certain communications in the London Lancet and other re-
spectable periodicals, in which Sulphuric Acid has been highly extolled as a re-
medy in Cholera and Diarrhoea. Recently, during the prevalence of this disease
in our city, some of our most respectable Physicians have been induced to test
this medicine, and according to their testimony, with the most astonishing re-
sults. It has proved successful in several cases, marked by complete collapse,
— a cold, relaxed and clammy skin — sunken and retracted features — pulse-
less— with vomiting and colliquative discharges; and indeed all those fearful
symptoms which generally characterize the latter stages of this disease. Of
course, it is not contended that the medicine will relieve and restore those
who have been collapsed for hours ; in such cases Providence alone can avail
any thing. But in cases just sinking into and even already collapsed, the fol-
lowing formula has arrested the disease and brought about reaction :

I£ Acid Sulphuric, gutt xii

Acid Nitric, " x

Aqua Distil. f >$ iss

Sach. Alb. qs.

Fit. Mist.

Dose — Tea spoonful every ten minutes. The medicine speedily allays vom-
iting and checks the purging, and the pulse gradually but steadily rallies, and
reaction is in due time established. None of these cases have come under our
personal observation ; but we have assurances of the efficacy of this treatment
from medical friends in whose intelligence and veracity we place implicit con-
fidence.

We are now testing the remedy, but will not be able to report the result in
this number.

We hope our friends will give it a fair trial, should opportunity, unfortu-
nately, offpr. The patients take it readily, and it is scarcely less pleasant than
a lemonade. Whilst using the medicine internally, the usual revulsives and
counter-irritants may be employed externally.

138

The New-Orleans Medical and Surgical Journal,

EFFICACY OF FULL DOSES OF QUININE IN COMATOSE PERNI-
CIOUS INTERMITTENT FEVERS.

Comatose Pernicious Intermittent Fever is, among French writers, tantamount
to our Malignant Intermittent, attended or complicated with violent cerebral
symptoms. We read with much pleasure and instruction the report of two
cases of this form of fever in our industrious cotemporary, V Union Medicate
de la Louisiane, drawn up by Dr. Charles Faget of this city. One was the
case of a Priest — the other that of a negress. Both, during each returning
paroxysm, labored under stupor, or rather coma, with a small, feeble and rapid
pulse, cool extremities and tongue. With much tact and habiliie, Dr. Faget
detected the remittent nature of the disease, and forthwith decided upon the
only course of treatment upon which he could rely for success, being well
aware that each recurring access but diminished his chance of success. With
as much boldness as skill, he resorted to full doses of the Sulphate of Qui-
niue, regardless of the comatose symptoms, and had the gratification of rescu-
ing both his patients from death. He gave 35 grains of Quinine to his cleri-
cal patient at one dose, and gradually reduced it daily. As the heat returned to
the extremities, the pulse rose and became full, and the head symptoms yielded.
The negress was treated in a similar manner, with the addition of cold affu-
sions upon the head, and she too gradually rallied.

What would have been the issue of these two cases, had Dr. F. made a
false diagnosis ? Had he overlooked the essential element, the pernicious char-
acter of the paroxysms, both must have perished ; because Quinine is the
only agent that can avail us under such circumstances. Great credit then is
due Dr. F. for the display of so much diagnostic skill and courage in the treat-
ment of the above cases.

We have barely alluded to this subject, and regret that we cannot make
room for the full details of all the interesting particulars connected with the
report.

PROF. RIDDELL'S MICROSCOPIC OBSERVATIONS.

In this number Prof. Riddell resumes his microscopical observations, which were
continued up to our March number. They wilt be found highly interesting, and have
been illustrated by engravings on stone, at a heavy expense to the proprietor. They
relate chiefly to the peculiar structure of the blood, and will be continued on this and
kindred subjects, in our future numbers. We are fortunate in securing the labors and
contributions of a gentleman so highly gifted and zealous in the cause of microsco-
pical science. The power and accuracy of his instruments, and his tact in using
them, will enable him to throw much additional light on many physiological and pa-
thological questions, hitherto undetermined by his predecessors or contemporaries.
Prof. R. will continue his labors, and we shall lay the result before our readers.

Dr. Macgibbon furnishes us for this number an anomalous case of double uterus,
illustrated by plates engraved on stone. It deserves a careful perusal.

Editorial. — City Intelligence.

139

ABSTRACT OF A METEOROLOGICAL JOURNAL FOR 1852.

BY D. T. LILLIE & Co., at the City of New Orleans.

Latitude, 29 deg. 57 min. ; Longitude, 90 deg. 07 niin. West of Greenwich.

WEEKLY
1853.

THERMOMETER.

BAROMETER.

COURSE
OF THE
WIND.

FORCE

WIND,
Ratio
1 to 10.

Number of
Rainy Days.

(oiuantity

txAliN

Inches.

Max.

Min.

Range.

Max.

Min.

Range.

April

83 .0

49 .0

34 0

30 .00

29 .85

0. 15

2.75

0.465

85 .0

56.0

29 .0

30.20

29 .95

0.25

SE.

2.10

0 875

May

87.5

68 .0

19 .0

30 .30

30 .05

0. 25

2.20

0.005

88.0

67.0

21 .0

30.25

30.10

0. 15

E.bys.

1.80

0.000

89 0

71 .0

18.0

30.13

30.10

0.03

1.85

0.015

87.5

68 .0

19.5

30 .12

29 .95

0. 17

sw.

1 .60

3.295

June

86 .0

69 .0

17 .0

30 .05

29 .85

0. 20

N.E.

2.00

1.660

88 .5

72 .5

16.0

30.20

29. 95

0. 25

2.15

0 015

89 .0

72 .0

17.0

30.25

30 .15

0 .10

2.50

0.260

The Thermometer used for these observations is a self-registering one, placed in
a fair exposure. Regular hours of observation : 8 A. M., 2 P. M., and 8 P. M.

CHARITY HOSPITAL,
Report for April and May, 1S52.

SEX.

APRIL.

MAY.

Admissions - -
Do. ...

Discharges - -
Do. - - -

Deaths - - -
Do. ...

Males
Females

699
287

986

693
282

975

84
28

112

829
384

1213

705
302

1007

148
5-4

202

There have been from the 1st of April up to this day, (18th June)
178 deaths from Cholera in the Charity Hospital.

JUSTIN V. LOUBERE,

Assistant Clerk.

RESIGNATION.

Prof. Thomas D. Mitchell has resigned the chair of Theory and practice in
the Philadelphia College of Medicine.

THE NEW-ORLEANS

MEDICAL AND SURGICAL JOURNAL.

SEPTEMBER, 1852.

Part first.

ORIGINAL COMMUNICATIONS.

I. — VERATRUM VIRIDE,
Green Hellebore— * American Hellebore.

New Orleans, May 5, 1852,

A Hester, M> D.

Sir — Intending to remain for several days in your city, we have de*
termined to occupy our leisure moments in noticing, to some extent, the
evidence we hold of the valuable remedial powers of the above article
or agent. We trust, in all our dealings with our patients, as well as
our medical brethren, that we have endeavored to honor and advance
the science and art to which we belong. If any person will take the
time and trouble to read with care and attention three articles written by
us, and published in the June number, 1850, January number, 1851,
and January number, 1852, of the Southern Medical and Surgical
Journal, of Augusta, Georgia, he will find a faithful and unvarnished
statement of the powers and properties of the above agent ; and from
which statement and facts we have no reason nor cause for changing in
the smallest degree any thing there said and set forth, unless after re-
peatedly testing it on our own person, we would be induced to deny
that it possessed narcotic powers. But more of this in future. We
have the most ample and conclusive evidence in our possession, corrob-

142 The New-Orleans Medical and Surgical Journal.

orative and positively sustaining and confirming every particular as
set forth and claimed.

We will briefly repeat here what we have stated elsewhere — that it
is emphatically the only known agent by which arterial action can be
certainly and effectually controlled. That by virtue of this power, in
connection with its diaphoretic, nervine, expectorant and emetic proper*
ties, we are enabled to break up and arrest Pneumonia Typhoides at
the outset, and to cut short and cure it when fully formed, with a cer-
tainty and promptness unknown to any other agent or remedy. By it
Typhoid Fever stands disarmed, and has acknowledged in Veratrum
Viride a victor, and a subduer and mitigator of its heretofore unman-
ageable symptoms or effects. In one word, it is more or less adapted
to the treatment and cure of acute febrile and inflammatory diseases of
a remittent and continued form. We will simply enumerate a list of
diseases in which it is peculiarly adapted, and successfully meets the
indications therefrom arising: Pneumonia Typhoides, Typhoid Fever,
Rheumatism, Scarlet Fever, Puerperal Fever, etc., etc. AlsoinAsth*
ma and Hooping Cough, accompanied with high febrile excitement ;
Convulsions in children from one year old and upwards — are subdued
with the greatest promptness, when found in connection with strong
febrile symptoms ; in acute affections, or inflammation of the brain,
and in delirium associated with or supervening on ebrileand inflamma-
tory diseases. But we omit to state further on our own knowledge and
observation of its powers, knowing how prone we are to be influenced,
like other men, by the effects of any favorite agent or measure that may
have originated or been proposed. We will give, in conclusion, and
in confirmation of what we have asserted and stated, what others have
written us.

With a large number of the gentlemen from whom we quote, we have
never had the pleasure of but a very limited personal acquaintance.
Professor Dickson writes :

" I have used and distributed freely to my friends for experiment, the tincture
you sent rne. I have prescribed several times, and in various cases, the Vera-
trum as prepared by you. I have found it a very efficient drug ; and am dis-
posed to entertain strong hopes of great benefit from it. In one case of Pneu-
monia it appeared to control and arrest the disease with a promptness I have
never seen equalled. It does diminish the frequency of the pulse with more
certainty than any thing else in the materia medica. I have from those to
whom I gave it, reports corroborating^these statements, and highly favorable to
the efficiency and energy of the Veratrum Viride."

Dr. T. Ridley, of Lagrange, Georgia, states :

Dr. Norwood on Veratrum Viride.

143

I have used the article furnished above extensively in my practice for the
last three months, and consider it one of the most valuable acquisitions to the
profession which has been made in the last half century. * *

It is, in high inflammatory action of the circulatory system, dependent upon
organic or functional disease, what Quinine is in paroxysmal diseases, a cer-
tain and reliable specific. When 1 first heard of the remedy and the astonish-
ing effects which its friends declared it exerted upon the human system, 1 was
inclined to look upon it as another of the thousand and one humbugs with which
the public were so frequently afflicted. * * I looked upon it

with suspicion, and at first commenced its use with very great caution and
circumspection. I very soon found it a remedy of great value ; and from the
moment I first commenced its use until the present time, I have never adminis-
tered it in a single case, but with the happiest results. In Pneumonia Typho-
ides I consider it a specific. In Typhoid Fever, which physicians have con-
sidered an ' opprobrium medicorum,' before the introduction of the Veratrum
Viride, it has exerted the happiest influence, controlling the circulation and
reducing the pulse from 140 and 145 to 70 and 75 in the short space of eight
hours."

After stating at length its wonderful powers in the cure of Typhoid
Fever, he continues —

"At a time like the present has been, (1851) when the ' pestilence which
walketh in darkness' has been making such fearful assaults upon the lives of
the wise, virtuous and good, a remedy which exerts such a controlling influ-
ence in checking its heart-rending influences, is worth more than armies to the
public good."

Dr. Billing of Columbus, Georgia, writes us :

" I left home for Marion a few days after you. When I returned I found
Dr. Boswell (his partner) in full blast with the Veratrum Viride. Visited his
cases with him ; have used it in a few cases myself, and in every case it was
sure to reduce the pulse. I am as well pleased with it as I andcipaied, and as
much so as any one medicine 1 ever used. I have no idea you claim for it as
much credit as it is entitled to. Four out of the six ounces are used, and we
will soon need more. Every physician here (Columbus, Georgia) who has
used it, is pleased with it so far, as I am informed. A gentleman in whose
family I used it, requested me to get him some of it. He observed, I intend to
get it and keep it in my family, at least so long as Pneumonia and Typhoid
Fever continue I know where it was the cause of one physician getting the
practice from another, because he had the Veratrum Viride."

In another letter, dated April 28th, 1852, we have the follow,
ing :

" The Veratrum Viride is all you claim for it. I have not the time to go
into minutiae. The first lot purchased has been consumed, or nearly so. It

144 The New-Orleans Medical and Surgical Journal.

has never failed in my hands to reduce the pulse ; and I have used it in very
bad cases. * * My opinion is that it is one of the greatest

discoveries of the age, and would not be without it for any consideration.
* * All the profession want is to see it used, to yield implicit faith

to its ability. And my opinion is that the time will come when a physician
would not think of ordering a bill of medicine without having your preparation
first on the list. Superior to the lancet by far, or any other nauseant. I am
not an enthusiast. This is my opinion from mature reflection."

Dr. Ellis of Oglethorpe City, Georgia, writes thus after one year's
experience and use of the article :

" Please pardon me for not giving you earlier the result of my experience
with the Veratrum Viride. * * I can truly say that I have

never found any remedy that produced its specific effects so certainly. In my
hands it has never failed. I have used it in Scarlet Fever, Pneumonia,Typhoid
Pneumonia, Typhoid Fever, Inflammatory Rheumatism, and in all cases where
I wanted to lessen the frequency of the heart's action, and in no instance has
it failed. In your published articles you have claimed much for it ; but not
more, nor as much, as it really merits; for if there is any thing in nature en-
titled to confidence to such a degree as to amount to a certainty, it is most
undoubtedly the article. I hope the profession will universally adopt its use,
and thereby secure for the science a triumph it so justly merits in saving
thousands from an untimely grave."

Dr. J. F. Moreland of Corinth, Herd County, Georgia, after stating
the certainty of its powers in the most striking manner, concludes
thus :

" My testimony as a medical man of some experience may, however, be
briefly stated to be decidedly favorable to the use of said article, believing, as I
do, that no physician can use it without regarding it as a very efficient article,
and such a one as in its specific control of the action of the heart in feverish
excitement, fully meets our heretofore earnest desideratum. Digitalis suc-
ceeds in one case out of twenty, perhaps ; this preparation in nineteen out of
twenty, more certainly. So much at present in reference to my appreciation
of the use of your preparation of Veratrum Viride. I k now that I am sin~
cere, and do not think that I am enthusiastic beyond a reliable matter of fact."

Dr. E. L. Roy Antony, Waynesboro, Georgia, writing as for infor-
mation or a supply for making of a pint of the tincture, and after-
wards for his friend Dr. Montgomery, of the same place, observes
thus :

" Allow me to say that I was in possession a year ago of two ounces, and
I shall be enabled shortly to corroborate all, and more than you have written
upon that article."

Dr. Norwood on Veratrum Viride.

145

We could give other and almost numberless quotations from medical
gentlemen, whose letters we have not with us — Dr. Fair of Columbia,
South Carolina, Dr. Ruff of Newberry Court House, South Carolina,
Dr. Robison of Winsboro, South Carolina, etc. etc. We have in our
possession letters, from New York to Missouri, inclusive, and would
be much pleased if we had it in our power to supply and answer all
those who have written to us.

We always make it a rule to leave written directions for giving any
medicine that may require the dose to be repeated. How persons can
leave verbal directions and have them properly executed, by a class of
individuals wholly unacquainted with, and unaccustomed to, such duties,
is a marvel to us. And why more serious accidents do not oftener occur
than really do, we cannot wholly account for, unless it is in this way,
that those to whom the administering of the medicine is left feel them-
selves responsible, to some extent, and conceal events that they feel
accountable for in some measure, when in fact the physician has as-
sumed the whole responsibility, by leaving nothing but verbal direc-
tions. Mere statements on the effects, or from the effects of medicines,
should never be relied on as evidence, unless predicated on a well
written set of directions.

The above remedy is subject to the same rules and regulations as
other active agents of the Materia Medica. In directing a medium
dose, we presumed it would be understood as a general rule and direc-
tion, and that the good sense of the physician would be looked to, to re-
gulate it according to temperament, idiosyncrasy and susceptibility, as
in like cases with other medicines. Ten grains of Calomel is a medium
dose for an adult ; yet we know a lady on whom one grain will act
drastically. One grain of Opium is a medium dose ; we know a per-
son who cannot take five drops of laudanum without suffering all the
consequences of a full dose. Two to four and six grains of Tart. Em-
etic is a medium emetic dose ; yet we know cases of athletic men on
whom the fourth of a grain will act for an hour, unless arrested by
Opium in some form, and mustard plasters or rubefacients. We know
personally two ladies, who, on taking Opium, have the most violent
pain, spasm or cramp excited in their stomach ; we have heard of
others thus affected. We know a person who cannot take Quinine
without having the most intense and agonizing pain excited in the sto-
mach. We have heard, on the best authority, that even the 48th of a
grain of Strychnine produced some of the peculiar effects of this article,
What would have been the result, if any of those who were so pecu-
liarly susceptible, had taken a medium-sized dose ? So that the prac-

146

Tlie New-Orleans Medical and Surgical Journal.

tice of medicine is one of watchful care, intense labor, and deep and
abiding responsibility ; and he who neglects to administer a powerful
remedial agent, because it requires caution and care, discrimination
and discernment, is as morally and religiously culpable and accounta-
ble, as he who wantonly and carelessly administers the same, having
full knowledge of its active powers.

In conclusion, being fully and forcibly impressed with our account-
ability to a higher bar than merely public opinion, we feel constrained
to offer to the full confidence of the medical profession Veratrum Viride,
with a former assertion, that it can be as easily, readily and safely
given as any other equally active and efficient agent.

W. C. NORWOOD,

Of Cokesbury, South Carolina.

II. — WOUND OF THE LIVER — EXCISION OF A LARGE PORTION
OF THE RIGHT LOBE.

BY J. C. MASSIE, M. D., OF HOUSTON, TEXAS.

Some three weeks since I was summoned, in great haste, to visit a
gon of Mr. Simmons, at a distance of some thirty miles from this city.
A brother of the unfortunate youth wounded, had a gun lying across his
lap, picking the flint ; it went off, the contents of the whole load passed
into the right hypochondrium, and mostly out about the region of the
epigastrium. The youth, who is about seven years of age, was stand-
ing close to the gun, and it was charged with large shot ; a portion of
the liver protruded through the external wound. A physician in the
neighborhood was sent for, who reached the case about four hours after
the accident. After examination, he viewed the case as hopeless, and
consequently declined doing any thing ; he visited the case, however,
on the next day, and advised that I should be sent for On the fourth
day after the accident I visited the patient, accompanied by my friend
Dr. Black. We found him in a very deplorable situation ; the anterior
margin of the right lobe of the liver was protruding through the ca-
vity on the right and a few lines above the umbilicus ; it was in a
gangrenous condition, with a portion of the omentum attached ; the sub-
stance of both was so much altered, that it was really difficult to tell
what the protruding portion was ; the abdomen was very tense and

Dr. Massie on Wound of the Liver.

hard, the least pressure giving severe pain ; there was great arterial
excitement, accompanied by a high inflammatory fever. This is a brief
and very succinct account of the condition of the little patient, and my
friend Dr. Black, as well as myself, regarded the case in a hopeless
condition. I informed his friends, after making known to them the
danger of the operation, that I would operate, remove the gangrenous
portion of the liver, and give him all the possible chance there could
foe left for his life. From the external character and appearance of the
wound, I was fearful gangrene had extended within the abdominal pa-
rieties.

I commenced the operation by enlarging the orifice about four
inches ; on examining the substance of the liver, I found two shot had
passed at least two and a quarter inches from its inferior border, pene-
trating through it ; the substance of the liver which was in juxtaposi-
tion to the wounds had a thick, grumous appearance, with sphacelated
portions. Under the circumstances, I determined to excise every por-
tion of the liver which had the appearance here described.

Blanchard, in his Anatomica Practica Rationalise says, " A small
portion oj^the substance of the liver may be removed without necessa-
rily inducing a fatal result and Dr. Henen, (Mil. Surg., p. 439) says,
** A deep wound of the liver is as fatal as if the heart itself was en-
gaged."

I felt great apprehension in excising the amount I was necessarily
compelled to do, and when I inform you that I excised quite one half
of the right lobe, equal to twice the amount of the left, you will then
see how easy it is for persons high in the profession to make statements
without proper data.

When the operation was finished, I passed a strong suture through
the abdominal parieties, closed the wound, and subsequently a vigorous
antiphlogistic treatment was adopted. I will not encumber your pages
with a long detail of the daily treatment of this case. Nothing very
remarkable, except for about ten days his discharges were passive, and
he could exert no control whatever ; at the present time he is able to
exercise in his room, secretions natural, wound nearly healed up, and I
consider him entirely out of danger.

This is an instance among many which may occur, and which may
serve to prove to the profession, that a case, however desperate it may
appear, should never be given up without an effort ; and I do deem it
very reprehensible,when professional men retreat, if I may use the term.

148 The New-Orleans Medical and Surgical Journal.

in desperate cases. An operation once undertaken, should always be
concluded secundem artem- — according to the circumstances of the case,
however desperate maybe the supervening results, or the obstacles that
may seem to render the operation unavoidable. Sometimes he will
find, in spite of all opinions, the patient recovers. I had a patient to
lie apparently lifeless, in Grimes County, which is well recollected, un-
der my own Scalpel, and under this embarrassing situation I finished
the operation, and my doing so is the means of his present enjoyment
of health, and his friendship to me.

I was kindly assisted by my friend, Dr. Black.

til.— AN ESSAY ON SORE THROAT, OR CHRONIC PHARYNGITIS.

Read before (he Memphis Medical Society, May, 1852.

BY A. P. MERRILL, M. D.

This disease is of frequent occurrence, sometimes being caused by
acute inflammation of the lining membranes of the throat, and some-
times by scarlatina, measles, exposure to cold, etc. It consists of a
subacute inflammation or hyperaemic condition of the mucous membrane
of the pharynx, frequently involving the tonsils and palate, the glottis
and epiglottis, and extending into the nares and Eustachian tubes, and
even into the external meatus of the ear. The membrane presents in
these cases a highly vascular condition, and sometimes an evident
thickening or hypertrophy, and not unfrequently an cedematous ten-
dency.

In cases of severity there is a pretty constant tickling in the throat,
producing a disposition to cough or to hack, a feeling of irritation and
roughness about the palate and glottis, painful deglutition, and an in-
crease of all the unpleasant symptoms consequent upon an over strain-
ing of the voice, followed by hoarseness, and in some instances by tem-
porary or permanent aphonia. In such cases, the secretions from this
membrane are nearly suspended ; but with a partial abatement of vas-
cular action, a viscid mucus is formed, which adheres closely to the
surface, and by the irritation it produces, causes coughing.

As in other cases of subacute inflammation of the mucous membrane,
a long continuance of this disease sometimes leads to ulcerations. The
ulcers are generally of a phagedenic character, spreading rapidly, with

Dr. Merrill on Sore Throat.

140

considerable waste of substance, and exceedingly sensitive to the touch.
The act of deglutition, while these ulcers exist, is attended by acute
pain, like the thrust of sharp instruments into the flesh. Sometimes
the ulcerative process is of the pustular character, producing pustules
or pimples considerably elevated, and filled with matter. This form of
the disease has been called " Follicular Pharyngitis."

Chronic Pharyngitis sometimes has its beginning in early youth, and
continues without any very urgent symptoms for many years. Persons
troubled with this form of the disease are "apt to experience a tickling
in the throat, attended by a collection of viscid mucus, and a disposition
to cough, or to hawk, upon every sudden transition from warm to cold
air, and particularly upon first going out in the morning, in cold and
damp weather. But these symptoms pass off as the day advances and
the system becomes warmed by exercise.

When the hyperemia and turgescence are much increased from any
cause, a rupture of some of the engorged blood-vessels is a common oc-
currence, and the patient ejects mucus tinged with blood, which is
hawked up from the throat. By close attention to this act, it is easy to
distinguish such cases from those of Bronchitis, in which bloody sputum
is coughed up from the lungs. And it is not difficult for an experienced
observer to distinguish Pharyngitis in all its stages from Laryngitis,
Trachitis and Bronchitis, even by the act of coughing or of ejecting
sputum from the throat by convulsive efforts, which are short of cough-
ing, generally called hawking or clearing of the throat. Pharyngitis
leads to the establishment of those other diseases, however, by the ex-
tension of the diseased action into the air passages, and then the two
affections exist together. This is the result so much to be dreaded,
and which makes the early and skilful treatment of the disease of the
utmost importance.

Habitual coughing, to a greater or less extent, is a common symptom
attending Pharyngitis, and it is one which requires our particular at-
tention. I believe it is a well ascertained fact, that the lungs cannot
be exercised by frequent and long continued coughing, from any cause,
without danger of the most serious consequences. The bronchial
tubes are certain, sooner or later, to take on an excited and diseased
condition from this convulsive movement, with every danger of hemorr-
hage and ulceration supervening, attended by hectic fever and other
characteristic symptoms of Phthisis Pulmonalis. Indeed a large ma-
jority of the cases of Consumption which I have met with, have had
their origin in a cough proceeding from the irritation caused by chronic
Pharyngitis. Persons of a strumous habit, and those wholabw under.

150 The New-Orleans Medical and Surgical Journal,

the disadvantages of a hereditary taint, are perhaps more liable to this
result than others, and experience its fatal influence in a shorter period
of time; but the exciting cause is the same, and the course of the dis-
ease very similar.

This disease is commonly called Bronchitis, but this is an erroneous
designation, for the bronchial tubes are not primarily affected, and
when they do become seriously involved in the diseased action, it is
not long before a name of more fearful import is assigned to it. We
hear then of Consumption and not Bronchitis,

Public speaking is one of the most exciting causes of Pharyngitis,
and clergymen, therefore, appear to be particularly obnoxious to it.
This arises mainly from the unnatural and labored efforts which they
are accustomed to make, together with their want of knowledge of the
physiology and philosophy of the human voice. These efforts are in
some cases repeated very often, in consequence of the high estimate
which Christians of the present day place upon such preachmg ; and
they are frequently made in over-heated and corrupted atmosphere, the
transition from which to a colder and purer medium, in a stale of
fatigue and exhaustion, has a strong tendency to enhance the ill
effects.

The usual remedies for this disease are counter-irritants externally,
and stimulating and escarotic applications to the diseased surface. The
former consist of blisters and various kinds of stimulating embroca-
tions, accompanied by the use of flannel or silk to protect the throat
from the influence of the cold air. The beard is sometimes permitted
to grow for the same purpose. Sometimes a contrary course has been
pursued, and the whole neck has been bared to the weather, with fre-
quent cold ablutions, general cold bathing, and even the application of
ice. These various remedies have their advocates, and no doubt all
have proved useful under certain conditions.

The applications made to the throat internally are, Capsicum, the
Sulphates of Copper and Zinc, Nitrate of Silver, etc. Capsicum has
been found very useful in many cases, from its actively stimulating effects
upon the torpid vessels, by which they are made to contract their cali-
bres, and thus reduce the prevailing hyperamia. A healthy secretion
of mucus sometimes follows this application, and a consequent relief of
urgent symptoms. The principal fault in its application consists in its
being prescribed as a gargle. Used as such, in the general accepta-
tion of the term, it does not reach, to much extent, the diseased surface v
but comes in contact principally with the mouth and lips, annoying the
patient by its burning stimulation, without much influence over the dis-

Dr. Merrill on Sore Throat.

151

ease. The best way of applying it is, by the use of a camel's hair
brush, or a bit of sponge, using a strong decoction, and washing it
well over the diseased surface. Or, if the patient throws back his head,
and by the use of a small spoon carries a few drops far back upon the
root of the tongue, and then swallows with the throat in this straight-
ened position, he will bring the liquid into contact with a considerable
portion of the diseased membrane, and avoid at the same time its un-
pleasant effects upon the lips.

The Nitrate of Silver has latterly been in higher repute in the treat-
ment of this disease, than any other topical remedy ; and it is at this
time, I believe, more generally prescribed. It is no doubt valuable,
and I have myself witnessed the happiest effects from its application,
both in solution and in substance. In one case of considerable vio-
lence, however, phagedenic ulcers formed in the throat while the patient
was applying a strong solution of the Nitrate of Silver to the part af-
fected, three times a day. These ulcers were cured, and the disease
greatly relieved by the substitution of a solution of Sulphate of Copper.
But I need not pursue this subject of treatment, which is so familiar to
you all, and will therefore proceed without further remark to the special
object of this paper.

It will be recollected by some of the members present, that several
months ogo I invited the attention of the Society, verbally, to the use
of Iodine as a topical application to the internal throat, in this disease.
I had at that time only a limited experience with the remedy, but had
witnessed remarkable effects from its use in several cases. And now,
after some further trials by myself and others, I am so far confirmed in
my favorable opinion of the remedy, as to feel myself called upon by a
sense of duty to the profession, to this Society, and to mankind, to
direct your attention to the subject in a more formal manner.

Having been in the constant use of this remedy in my practice for
more than a year, and having succeeded in relieving several cases of
Chronic Pharyngitis with it, which had resisted the use of other active
means of cure, I now venture to recommend it as a valuable remedy,
and to request the members of this Society to put its merits to the test
of experiment, as they have opportunity, and to report the result to the
Society.

The preparation which I have generally used is one of the solutions
of Lugol, consisting of Iodide of Potash 3 i, Iodine 3 ss, and water I i,
to which I generally add half an ounce of simple syrup. In obstinate
cases of long standing, the Iodine in this solution may be doubled in
quantity, but in most of the cases for which I have prescribed the re.

152

The New-Orleans Medical and Surgical Journal.

medy, the above proportions have proved sufficiently active. It is ap*
plied to the throat as extensively as possible, by meaus of a large camel's
hair brush. This is easily done by an assistant, while the root of the
tongue is depressed with a spoon handle ; or the patient, after a little
practice, may readily apply it himself. It allays titration and coughing,
and the application should be repeated as often as these symptoms be-
come troublesome, whether by day or by night.

The same solution is a valuable application for the external meatus
of the ears, but for this purpose glycarine should be substituted for the
syrup.

IV.— REPORT ON THE MEDICAL BOTANY OF THE STATE OF

LOUISIANA.

BY JOSIAH HALE, M. D.

The undersigned, Chairman of the Committee appointed by the Lou-
isiana State Medical Society, at the annual meeting in March, 1851,
" On the Botany and Natural History of this and the adjoining States,'*
begs leave to report as follows :

Your Committee, in discharge of a part of the duty assigned them?
present a catalogue of indiginous, naturalized, and a portion of the cul-
tivated plants growing in this State, that have been employed in medi-
cine, together with some observations on their medical properties.

DIVISION 1 POLYPETALOUS, EXOGYNOUS PLANTS.

Order, Ranunculacece. (Crowfoot Family.)

Many plants of this order have been employed in medicine, but with
few exceptions they are now neglected. They generally contain an
acrid principle, which is readily destroyed by heat, or is dissipated by
drying.

Clematis cylindrica, L. C. reticulata, Walt. C. Virginica, L. (Vir-
gin's Bower.)

These are climbing, shrubby plants ; they possess the general pro-
perties of the order, and the two last have been employed in medicine.
Diaphoretic and diuretic.

Anemone Caroliniana, Walt. (Wind-flower.) Acrid, rubefa-
cient.

Dr. Hale on the Medical Botany of Louisiana.

153

Hepatica triloba, Choix. (Liverwort.) Demulcent and slightly
astringent. Grows in St. Tammany.

Ranunculus sceleratus, L. (Butter-cup.) In the fresh state very
acrid, producing blisters with as much promptness as Spanish flies ;
when dry, inert. Several other species are natives of this State, soma
of which possess properties similar to the above.

Tbalictricum dioicum, L. T. Cornutii, L. (Meadow Rue.) The roots
deemed useful for snake bites. Raf.

Order, Magnoliacem. (Magnolia Family.)

The plants of this order, natives of this State, are all trees ; several
of them remarkable for the size of their leaves, and the magnitude and
fragrance of their flowers.

Magnolia Macrophylla, M. (Umbrella tree.) A rather small tree ;
leaves deciduous, large, occasionally lib' inches long by 12 in breadth.
Flowers large, fragrant, the petals 8 inches long by 3 wide.

Magnolia cordata, M. (Cucumber tree.) Leaves deciduous. J\L
grandiflora, L. (Large-flowered magnolia.) Leaves perennial, coria-
ceous, dark green shining above. M. glauca, L. (Swamp Laurel.)
A small tree ; leaves evergreen, flowers very fragrant. The medical
properties of all our species are identical, and may, therefore, be em-
ployed indifferently.

The bark of the Magnolia is a tonic bitter of considerable power ;
it was in use among the Indians as a remedy for autumnal fevers and
rheumatism, and has proved beneficial in the hands of regular practi-
tioners in the treatment of remittents having a typhoid character. The
cones and seeds are likewise employed to make a tincture, which is a
popular remedy in the treatment of chronic rheumatism, and a prophy-
lactic against intermittent fevers. Wood.

Leriodendron tulipifera, L. (Poplar.) The bark is simply bitter
and tonic, containing a small proportion of an aromatic property, and
an essential oil. It has been found by Dr. Emmet to contain a new
principle, supposed to be analogous to camphor. The bark of the-
Tulip tree closely resembles that of Magnolia in its medical proper
ties, but is less aromatic, and more stimulant. In warm decoction it
acts as a sudorific, and sometimes as a diuretic. Griff.

lllicium Floridianum, Ellis. A handsome evergreen shrub. Rark'
and leaves aromatic. Deserves attention. Grows in damp soil ; Co-
vington.

Order, Annonacece. (Popaw Family.)
Uvaria triloba, Tor. and Gr. (Popaw.) The succulent fruit is edi-

154 The New-Orleans Medical and Surgical Journal.

hie and much esteemed by those accustomed to it. A beer is made
from it. The seeds, eaten by children, have proved actively emetic.
The bark, by masceration, is capable of being manufactured into ropes,
Russia mats, etc. Grows abundantly in Rapides, and other parts of the
State. Alluvial soil.

U. parviflora, T. and G., and U. abovata, T. and G., are small
shrubs, in dry, sandy soil.

Order, Schizandracece. (Schizandra Family.)
Schizandra coccinea, M. A climbing shrub, with thick, soft, slightly
pungent and aromatic bark ; used in domestic practice as a substitute
for sarsaparilla, the name of which it bears in some parts of the
country.

Order, Menispermacece. (Moonseed Family.)
Coculus Carolinianus, D. C. Sometimes called Sarsaparilla, and
used as a substitute for it. Bitter, tonic.

Menispermum Lyonii, Ph. Moonseed Root. Bitter, tonic.

Order, Berberidacea. (Bearberry Family.)
Podophyllum peltatum, L. (May Apple.) Grows in fertile hills;
fruit edible. The root was in common use among the Indians before
the settlement of the country by the whites, and was considered by
them as one of their most powerful purgatives. (Grif.) In the hands
of physicians it has proved to be a certain and safe cathartic, rather
more drastic than Jalap. It is sometime harsh in its operation, giving
rise to tormina and profuse discharges. (Carson.) Combined with
cream of tartar it forms an admirable hydrogogue cathartic. Dose of
the root in powder, 10 — 20 grains. It has been used externally as an
escharotic to indolent ulcers. Besides resin and the usual constitu-
ents, it abounds in a peculiar principle called podophilline, which be-
longs to the same group with salicine and populine. The peculiar
properties of the root are probably due to this principle, and to the resin.

Order, Cabombacea. (Watershield Family.)
Brasenia peltata. Ph. Abundant in ponds, frequently covering
whole acres of their surface with its floating leaves. The jelly with
which the under surface of the leaves is thickly coated, is a pure mucil-
age, similar to that of lichen ; plant sub-astringent. (Raf.)

Order, Nelumbiacece. (Nelumbo Family.)
Nelumbium luteum, Willd. (Water Chinquepin — Wancopin.) This
magnificent aquatic grows in ponds and lakes, in most parts of the

Dr. Hale on the Medical Botany of Louisiana,

155

State. It is remarkable for the size and fragrance of its flowers, and
the dimensions of its large peltale leaves, which frequently exceed two
feet in diameter. They have the property of repelling water, when
thrown on their surface, giving to small portions a spheroidal form.
The roots are said by Nuttall to resemble the sweet potato in taste,
and are a favorite article of food among the Osage and other Western
tribes of Indians. The nuts, which are about the size of chinquepins,
resemble them in taste. The leaves are cooling, and form a good
dressing for blistered surfaces. (Griff.)

Order, Nymphacece. (Water Lily Family.)

Nymphcea odorata, Ait. (White Water Lilly.) Leaves floating, roots
large and fleshy. Used as a popular remedy in bowel complaints.
They contain, according to Bigelovv, tannin and gallic acid.

Nuphar lutea, Smith. (Yellow Water Lilly.) Medical properties
similar to Nymphoea, but weaker. The roots, rubbed or bruised with
milk, are said to destroy cockroaches and crickets.

Order, Sarraceniacece. (Pitcher Plants.)
Sarracenia flava, L. (Yellow flowered Side Saddle.) Leaves one
to two feet long; half full of water and dead insects. According to
Dr. Porcher, the root has long been used as a domestic remedy by the
inhabitants of the lower portions of South Carolina. From his obser-
vations and experiments, it appears to be a stimulant and tonic, with a
tendency to act on the brain, and is probably well suited to cases of
dyspepsia, dependent on debility of the stomach. Prof. Shepherd found
the root to contain, besides resin and other matters, an acid salt of lime,
and a salt probably of an organic alkali. Grows in wet pine woods.
(Wood.)

S. purpurea, L. (Purple flowered Side Saddle.) Tubes usually
half full of water and dead insects. Properties, probably similar to
the above. Damp soil, Covington.

Order Papaveracece. (Poppy Family.)

Papver somniferum, L. (Poppy.) The opium bearing poppy is a
native of the warmer parts of Asia, but is naturalized in almost all parts
of the world, and might, perhaps, be brought to yield opium in this
country in sufficient quantity to repay the labor of cultivation.

Argemone Mexicana, L. (Prickly Poppy.) The whole plant ex-
udes an acrid, milky juice, which on exposure to the air becomes con-
crete like gamboge. Is found of service in chronic diseases of the
skin.

156 The New-Orleans Medical and Surgical Journal.

In Brazil and India, the expressed oil of the seeds is regarded as a
purgative not unlike castor oil, but more active, thirty drops being equal
to an ounce of castor oil. It operates without griping.

Sanguinaria Canadensis, L. (Puccoon, Blood root.) Grows in the
North-west portion of the State. The whole plant is pervaded by an
orange colored juice, most abundant in the root. Dr. Dana has shown
that sanguinaria owes its medical properties to an alcaloid principle,
which he has called sanguinarina. It is extremely acrid, and possesses
the properties of an alkali. Sanguinaria has been advantage-
ously administered in many diseases of the lungs, and has been
recommended in rheumatism and diseases of the liver. The dose of
the powdered root, as an emetic, is 10 — 20 grains; as a diaphoretic
and expectorant 3 — 5. Externally, the decoction has been found useful
as a wash for ill-conditioned ulcers. The powdered root is also an
efficient escharotic.

Order Fumariacea. (Fumitory Family.)
Corydalis aurea, Willd. Corydalis glauca, Ph. (Fumitory.) Diure-
tic and diaphoretic.

Order Cruciferce. (Mustard Family.)
This is a vast and very natural family of plants, all the species com-
posing it being closely allied in structure and properties. They are
all more or less acrid and pungent. In some of them this acrid princi-
ple is in union with a considerable quantity of mucilage, when they
become useful articles of food. The acridity depends on a volatile oil,
which is dissipated by heat. K very large number of our culinary ve-
getables and condiments are derived from this class, as all the varieties
of Cabbage, the Turnip, Mustard, Horse Radish, Cress, etc. Several
of our indigenous species are esteemed as salads, as Cardemine rotun-
difolia, M. ; C. Virginica, L. ; C. Ludoviciana, Hook; Seuebriapinna-
tifidia, D. C; Lepedium Virginicum, L., etc. They are all valuable
antiscorbutics.

As medical agents they are of little importance, though from the pun-
gency of the volatile oil contained in some of them, they are frequently
employed as external stimulants, and sometimes administered internally
to excite the intestinal canal. (Grif.)

Order, Violacea. (Violet Family.)
Viola pedata, L. Foot Violet. This species is remarkable for the
size and beauty of its flowers, which are usually bright blue, in some
varieties pale blue, and even white ; one variety has the two lower

Dr. Hale on the Medical Botany of Louisiana.

157

petals dark purple. The root has been employed as a demulcent and
expectorant.

Viola odorata, L. (Fragrant Violet.) A native of Europe, but na-
turalized in some places in this country. It is cultivated in every gar-
den for the delightful odor of its flowers. The syrup prepared from this
species is demulcent and laxative, and is of great value to the chemist
in the detection of acids and alkalies. The root is emetic and cathartic,
in about the same doses as Ipecac, for which it has been proposed as a
substitute, but is less certain in its operation. It owes this property
to a principle called violine, closely allied to emetine in composition and
action.

V. tricolor, L., and V. arvensis, Ell., (Heart's Ease) are said to be
possessed of efficacy in the treatment of cutaneous diseases, especially
crustea lactea.

V. palmata, L. A variable species ; one variety with flowers of
bright purple, and fragrant.

This violet is very mucilaginous, and much used by the negroes in
their soups. In domestic practice the bruised leaves are employed as
an emollient application. (Ell.) Grows in shady woods.

V. primulaefolia, L. Flowers white, fragrant.

V. lanceolata, L. Flowers white. Grows in wet places, about
springs, etc.

Order, Hypericacece. (St. Johnswort Family.)
A numerous family of herbs, or handsome shrubs, (with us) having
a resinous juice, variously and capriciously dotted with glands, leaves
opposite entire, capriciously dotted with immersed, pellucid, resinous
glands, and often (as also the sepals and petals) sprinkled with black
glandular dots or lines, Torr. and Gr.

Most of the plants of this order exhale, when bruised, a peculiar bal-
samic odor. The Indians frequently carry a handful of the Hypericam
Sarothra for days together, on account of the pleasant odor. All our
species of St. Johnswort possess medicinal properties in a greater or
less degree. Several of them were formerly employed as remedies for
intermittent fever, and a long array of other maladies, but they are at
present principally confined to domestic practice. Our genera are,
Ascyrium, St. Peterswort ; Hypericum, St. Johnswort ; and Elodea,
Marsh St. Johnswort.

Order, Portulacea. (Purslane Family.)
Portulaca oleracea, L. Purslane; naturalized. A cooling diuretic,
used in scurvy and affections of the urinary organs. (Wood.)

158 The New-Orleans Medical and Surgical Journal.

Order, Malvacece. (Mallow Family.)

Our indigenous plants of this large order are all herbaceous. Their
general character is that of abounding in mucilage, and being destitute
of any unwholesome properties.

Malva Caroliniana, L. (Guimauve.) Very common. From the
great quantity of mucilage it contains, is used in bowel affections. It
forms an excellent cataplasm in external inflammation.

M. papaver, Nutt. (Poppy Mallow.) Remarkable for the size and
beauty of its flowers. Properties, in a slight degree, those of the
order.

Hibiscus incanus, L., and many others, are mucilaginous.

H. esculentus (Okra). Introduced from Africa. Cultivated and
highly esteemed as a culinary vegetable. It abounds in mucilage, and
may be employed medicinally in all cases requiring demulcents and
emollients.

Gossypium album, Ham. (White-seed Cotton — Mexican Cotton.)
G. nigrum, Ham. (Black-seed Cotton — Sea Island Cotton.) It is
probable these are the only original species of this very important genus,
the numerous varieties being the effect of cultivation. Dr. F. P. Por-
cher (Transactions American Medical Association, II. p. 721) remarks,
" Much use is made of the roots of the cotton in this State, (South
Carolina) in the treatment of asthma, a decoction being employed. It-
appears, moreover, to have a specific effect on the uterine organs. Dr.
Ready informs us that his attention was first called to its emenagogue
properties by an article in the New Orleans Medical Journal, some
years since. He has since used it in suppression of the menses, but
more particularly in many cases of flooding, with entire success. It
seems to produce as active a contraction of the uterus as ergot itself.
Three ounces of the root are infused in a pint of boiling water, of
which three or four ounces are taken internally every fifteen minutes."
The cotton-wool, when carded, or what is better, fresh from the receiv-
ing room, forms an excellent application to burns and scalds, and has
been recommended as a dressing to blisters, when it is wished to dry
them rapidly.

Order Tiliacece. (Linden Family.)
Tilia Americana, L. (Linden, Bass-wood.) The inner bark of this
tree affords a rich mucilage on masceration in cold water, which forms
a soothing application to irritable surfaces. (Williams.)

Order MeliacecB. (Melia Family.)
Melia azedarach, L. (China Tree.) This beautiful shade tree*

Dr. Hale on the Medical Botany of Louisiana.

159

common throughout the Southern States, is one of our most valuable an-
thelmentics. It is also of service in those infantile remittents which
resemble verminose, and which frequently occur without the presence
of worms. A decoction is made by boiling four ounces of the fresh
bark of the root in a quart of water, to a pint ; of this a table spoonful
is to be given every two or three hours, till it affects the stomach or
bowels ; it should be followed by a brisk cathartic.

Order, Oxalidacea. (Wood Sorrell Family.)
Oxalis violacea, L. ; O. stricta, L. ; O. corniculata, L. — (Wood
Sorrel.) All our species of sorrel possess 'an agreeable acid, de-
pendent on the quantity of binoxalate of potassa they contain. Used
to form a cooling drink in febrile complaints.

Order, Balsaminacea. (Balsam Family.)

" Impatiens fulva, Nutt. (Touchmenot.) The whole plant is acrid,
and is used as a cataplasm." Taken internally it acts as an emetic,
cathartic and diuretic. (U. S. Disp.) Flowers used in dying yellow.

I. Balsamina (Touchmenot,) of the gardens, an exotic, resembles the
last in its properties.

Order, Zanthoxyllaceae. (Prickly Ash Family.)

Zanthoxyllum Carolinianum, L. (Prickly Ash.) Bark aromatic
and pungent, a powerful stomachic and diaphoretic ; used in chronic
rheumatism ; dose, in powder, 10 — 20 grains.

Ptelea trifoliata, L. (Three leaved Ptelea.) A large shrub, said
by Schoepf to be anthelmintic, for which purpose the leaves and young
shoots are used in strong infusion. The fruit is aromatic and bitter, and
is stated to be a good substitute for hops. (Grif. Med. Bot.)

Order, Anacardiacecs. (Cashew Family.)
Trees or shrubs having a resinous, gummy, or milky caustic juice,
which in some of them turns black, and is used for varnishes.

Rhus radicans, L. (Poison Vine.) Grows in fertile soil, climbing
trees, etc.

R. toxicodendron, L. (Poison Oak.) Erect, one foot high, grows in
dry, sandy soil.

These species, possessing similar properties, were known to the
Indians both as poisons and medical agents. The poison oak has been
employed in paralysis, in which it appears to act like nux vomica, but
not with equal power.

160

The New -Orleans Medical and Surgical Journal.

R. vermix, L. Grows about springs, etc. Poisonous properties ex-
ceedingly active.

R.. glabra, L. R. typhina, L. R. copallina, L. (Sumach.) The
crimson berries of the three last named species, when mature, are co-
vered with an acid efflorescence, and have a sour, astringent taste,
which they readily impart to cold water, forming an agreeable drink in
febrile complaints. The bark of the root has been highly recommended
as a wash in salivation ; the leaves are employed in tanning Morocco
leather, etc. They are smoked by the Indians, either alone or mixed
with tobacco.

Order Acer acea, (Maple Family.)1
Acer saccharinum, L. (Sugar Maple.) Rubrum, L. (Red Maple.)
Drummondii, Hook and Arn. (Swamp Maple.) All yield sugar.
Negundo aceroides, Mcench. (Box Elder.) Yields sugar.

Order Hypocastanacea. (Horse Chestnut Family,)
iEsculus Pavia, L. (Buckeye.) A handsome flowering shrub, some-
times attaining the size of a small tree. The bark, among other ingre-
dients, contains galic acid and tannin, and imparts its properties to
boiling water. It has been employed as a substitute for Peruvian bark,
in the cure of intermittents. The fruit yields the finest starch, esteemed
for its pure and durable whiteness ; a strong paste may be made of it,
which is avoided by insects ; the roots are used for washing and
whitening woollens, silks, etc.

Order Sapindacece. (Soap-berry Family.)

Sapindus marginatus, Willd. (Soap-berry tree.) Fruit saponaceous;
said to be rather corrosive.

Cardiospermum Halicacabum, L. (Heart-seed, Bladdernutt.) The
root is aperient. (Ainslie.)

Order, Celastracece. (Spindletree Family.)
Euonymus atropurpureus, Jay. (Burning bush.) A shrub of rather
striking appearance, especially in winter, from the scarlet color of the
fruit, and inverted capsules, whence the name of Burning bush. Ca-
thartic and diuretic; requires investigation.

Order, Rhamnacece* (Buckthorn Family.)
Berchemia volubilis, D. C. (Souple Jack.) A climbing shrub, in
moist woods ; root used in cachetic diseases; said to be antisyphilitic.
(Lind.)

Dr. Hale on the Medical Botany of Louisiana.

161

Rhamnus Carolineanus, Walt. A shrub or small tree. Properties
probably similar to those of R. catharticus. Vide Wood and Bache's
Disp.

Ceanothus Americanus, L. (Red Root.) A small shrub, very
common ; the bark of the root imparts a red color to water ; astrin-
gent. Used advantageously in diarrhoea of children.

Order, Vitacece. (Vine Family.)

Vitis labrusca, L. (Fox Grape.) V. blanda, Raf. (Raisin de
Cote — Pine-woods Grape.) V. aestivalis, M. (Summer Grape.) V.
cordifolia, M. (Winter Grape.) V. rotundifolia, M. (Muscadine,
Scuppernong.) The cultivated varieties of several of our indigenous
species are much esteemed as table grapes, and for making wine.
Besides their use as an article of diet, grapes have been prescribed
medicinally ; they are antiseptic and cooling, and when partaken of
freely are somewhat diuretic and laxative.

Wine is the most important product of the vine. Grape sugar dif-
fers from every other kind of sugar in containing a less quantity of
carbon. The acid of the grape is chiefly the tartaric ; malic acid,
however, is contained in them.

Order, Polygalacece. (Milkwort Family.)
Polygala pubescens, Muhl, Covington. P. polygama, Walt. P. pur-
purea, L. P. sanguinea, T. and G. P. cruciata, L. P. lutea, L. P.
Nana, D. C. P. Cymosa, Walt. P. grandiflora, T. and G. P. in-
carnata, Muhl. P. verticillata. P. ambigua, Nutt. P. leptocaulis,
T. and G. These are, for the most part, small annual plants, the two
first only being perennial ; they all possess the properties of the P. se-
nega, and may be substituted for it. The fresh root has a feeble but
peculiar odor, and a bitter, slightly acid taste. It is a stimulant of a
very searching nature ; hence the impropriety of employing it in inflam-
matory diseases, as croup, pleurisy, etc., before the acute stage has been
subdued.

Order, Leguminosce. (Pulse Family.)
This extensive family is composed of trees, shrubs and herbs.
Erithrina herbacea, L. (Coral Flower.) Roots sudorific, flowers
pectoral ; very ornamental. Raf.

Apios tuberosa, Mcench. (Indian Potatoe,) Climbing ; flowers in
crowded racomes, sweet scented, roots tuberous, farinaceous, and edi-
ble. In wet places.

Baptisia lanceolata,Ell.; B. leucophoea, Nutt.; B. leucantha, T. and G.;

162 The -New-Orleans Medical and Surgical Journal.

B. australis, R. Br. (Wild Indigo.) The wild indigo has been used with
benefit, as an external application, in mercurial sore mouth ; also in
foul and gangrenous ulcers, correcting the vitiated discharges, and
checking the progress of mortification.

Indigofera tinctoria, L. (Indigo.) Formerly cultivated in parts of
this State, for the well known product Indigo, the process of preparing
which was known to the aborigines, before the discovery. Employed
as an astringent in immoderate discharges of the lochia, and more re-
cently in spasmodic diseases, especially epilepsy, but it appears, in
reality, to be possessed of very little power.

Indigofera Caroliniana, Walt. (Wild Indigo.) A beautiful peren-
nial species, growing in dry soil. Properties similar to the last.

Rabinia Pseudoacacia, L. (Black Locust.) The flowers possess
antispasmodic properties, and make an agreeable syrup. The bark of
the root is sweetish ; both cathartic and emetic.

Tephrosia Virginica, Pers. (Turkey Pea.) The roots were used
by the Indians as a vermifuge, before the settlement of the country by
the whites, and are a popular remedy at the present time. (Grif.)

T. onobrychoides, Nutt. ; T. hispida, Ph. ; T. spicata, T. and G.
These are all deserving attention.

Cassia Marilandica, L. (American Senna.) A rather showy plant,
growing in fertile soil. An active and certain cathartic, but little if at
all inferior to the foreign senna. The leaves should be gathered when
the fruit is nearly ripe.

C. occidentalis, L.; [Coffee Weed] C. obtusifolia, L.; C. chamsecrista,
L. ; nictitans. These appear to possess more or less active properties.

Order, Rosacea. [Rose Family.]

The plants of this order are herbaceous or shrubby ; none of them
bear poisonous fruits. " The roses are astringent, the spirese emetic,
and the amygdalae sedative." [Carson.]

Cerasus serotina, D. C. [Wild Cherry.] The wild cherry frequently
grows to the size of a large tree ; the wood is valuable ; the fruit eat-
able; the bark yields gum ; and the leaves, bark and kernels yield tan-
nin and amygdalin. [Carson.] It is one of our most valuable indi-
genous remedies, uniting, with a tonic power, the property of calming
nervous excitability. It is admirably adapted to the treatment of dis-
eases in which a debilitated condition of the stomach or of the system
is united with general or local irritation. It may be used in infusion
or in powder. Dose of the latter, 3 ss — 3 i. [Wood.]

Dr. Hale on the Medical Botany of Louisiana. 163

C. Virginiana, L. [Wild Cherry.] Properties similar in all re-
spects to the last.

C. Carol iniana, M. [Laurier Amand.] Probably the most efficient
of our species of Cerasus. The leaves are poisonous, frequently de-
stroying cattle that feed upon them.

Gillinia stipulacea, Nutt. [Indian Physic] The root is a mild and
efficient emetic. Dose, in powder, 20 — 30 grs.

Geum Virginicum, L. Tonic and astringent ; used in leuchoreaand
in diarrhoea.

Agrimonia Eupatoria, L. [Agrimony.] Has a weak but agreeable
aromatic odor, is a mild astringent and tonic ; said to have been em-
ployed by the Indians and Canadians as a febrifuge; useful in diarrhoea*
etc., and in passive hemorrhage.

A. parviflora, Ait. Properties similar to the last.

Potentilla Canadensis, L. [Cinquefoil], Var. Simplex, T. and G'
A mild astringent.

Fragaria Virginiana, Ehr. [Strawberry.] Strawberries are refri-
gerant, diaphoretic, pectoral and astringent. They have been used in
consumption, gout, scurvy and gravel. The root is bitter, astringent
and tonic ; beneficial in hemorrhages, etc.

Rubus villosus, Ait. [Blackberry.] R. trivialis, M. [Low-bush-
Blackberry.) R. Hispidus, L. [Dewberry.] All perennial; possess the
same properties.

Blackberry root is an efficient astringent, though not of great power,
and has been found exceedingly useful in bowel complaints, especially
in the cholera of children. [Grif.] It should be given in decoction,
an ounce of the root to a pint of water, of which the dose for a child is
two or three tea spoonsful, and for an adult a wine glassful.

The fruit is relished, and agrees wrell with most persons ; is found
beneficial in dysentery, especially in the form of jam or syrup. It is
exceedingly grateful to the patient, and often relieves the painful tenes-
mus so constantly an attendant of the complaint. [Grif.]

Order, Lyihracea. [Loosestrife Family.]
Lythum alatum, Ph.; L. lanceolatum, Ell. (Slender Loosestrife.) Ele-
gant perennial plants, with quadrangular stems and blue flowers, in
long terminal spikes. Demulcent and astringent.

Order, Onagracea. [Evening Primrose Family,]
(Enothera biennis, L. [Evening Primrose.] Mucilaginous and

161

The New-Orleans Medical and Surgical Journal,

slightly acrid. Employed in decoction with benefit, by Dr. Griffith, irt
obstinate cutaneous complaints.

Order, Cactacea. [Cactus Family.]

Opuntia vulgaris, Nutt. [Prickly Pear.] Young leaves eaten by
negroes like okra ; split leaves ; good topical emollient for acute rheu-
matism ; baked for chronic ulcers and wounds. The juice and gum
used for the gravel. [Raf]

Order, Passifloracece. [Passion Flower Family.]
Passiflora incarnata, L. [May Apple.] Fruit edible, of an agree-
able acid taste.

P. lutea, L. Fruit small ; dark purple. Several species of this
genus are employed in medicine, and these appear worthy of investiga-
tion.

Order, Cixurbilacece. [Gourd Family.]
Bryonia Boykinii, T. and G. Stem twining over bushes, etc. Fruit
half an inch long ; bright crimson ; root tuberose. Several species of
Bryony possess active medicinal properties.

S icy os angulata, L. [Prickly Cucumber.] Roots and seeds bitter,
purgative and diuretic. [Raf.]

Melothrea pendula, L. [Creeping Cucumber.] Stem slender; climb-
ing ; fruit the size of a pea ; black when ripe. Used in the West In-
dies as a pickle, when green. It is extremely drastic when mature ;
half a one being a dose for an adult.

Order, Saxifragacem. [Saxifrage Family.]
Huchera Americana, L. [Alum Root.] Root powerfully astringent;
was in use among the aborigines as a styptic, and an application to
ulcers ; may be used wherever an astringent is indicated.

Itea Virginica, L. A shrub, bearing racemes of beautiful white
flowers. Employed as a domestic remedy for intermittents ; it has
also been used in chorea.

Hydrangea arborescens, L. [Tree Hydrangea.] H. Querci folia, Bar-
tram, [Oak-leaved Hydrangea.] Dr. Griffith found the leaves tonic,
sialagogue, cathartic and diuretic. [Raf.]

Decumaria barbarea, L. [Sugar Vine.] A climbing shrub, fre.
quently ascending tall trees, adhering by means of radicles. The sap,
which in early spring is yielded abundantly from incisions, contains
sugar in considerable quantity.

Dr. Hale on the Medical Botany of Louisiana.

165

Hamamelis Virginiana, L. [Witch Hazel.] A large shrub remark-
able for flowering late in autumn, and maturing the fruit of the previ-
ous year, at the same season. The bark has been used as an external
application in painful affections, tumors, etc., in the form of poultice
and decoction ; also in painful hemorrhoidal affections.

Order Umbelliferce. [Parsley Family.]

The properties of this vast and important tribe of plants differ widely,
according to the part of the plant considered ; whether the vegetation or
the fructification. The character of the former is generally suspicious,
and often poisonous in a high degree, as the Hemlock, Fool's Parsley,
etc. Nevertheless, the stems of the Celery, especially when etiolated*
and the roots of the Carrot and Parsnip, are wholesome articles of food.
The fruit, commonly called the seed, is in no case dangerous, and is
generally a warm and agreeable aromatic.

. Sanicula Marilandica, L. [Sanicle.] Useful in leuchorea, gonorr-
hoea and dysentery. (Raf.)

Eryngium aquaticum, L. E. Virginicum, L. (Button Snakeroot.)
These species possess similar properties. The root has a bitter, pun"
gent, aromatic taste, provoking, when chewed, a copious flow of saliva.
Diaphoretic and expectorant, and in large doses occasionally emetic.
Used by some physicians as a substitute for senega. [Bigelow.]

Cicuta maculata, L. [Water Hemlock.] Grows in wet places ; one
of the most poisonous of our indigenous plants. The whole plant in
the fresh state is poisonous, but the leaves and stem become inocuous
on drying. The root, however, is the most active, and the cortical por-
tion contains a viscid, yellow juice. When taken in any quantity, the
Cicuta causes all the symptoms of the acronarcotics. It has been
used as a sedative to alleviate pain in schirrus and cancer.

Thaspium cordatum, Nutt. Vulnerary, antisyphilitic, sudorific; anti-
dote for rattlesnakes. [Raf.]

Order Araliacece. [Spikenard Family.]

Aralia spinosa, L. [Angelica Tree, Prickly Elder.] A large shrub,
growing in fertile woods. The inner bark is yellowish, of a slightly
aromatic odor, and bitter, astringent taste. It was in use among the
Indians for dropsy, cholic, syphilis and chronic rheumatism ; they gave
it in decoction. It is stimulant and diaphoretic, and in the recent state,
emetic and cathartic ; used in chronic rheumatism and in cutaneous
eruptions. A spirituous or vinous tincture of the berries, said to be

166 The New-Orleans Medical and Surgical Journal,

efficacious in relieving rheumatic pains. The bark is most commonly
administered in decoction.

Order Cornaceaz. [Dogwood Family.]
Cornus Florida, L. [Dogwood.] The bark is tonic, astringent and
somewhat stimulant, and is probably the best native substitute for the'
cinchona.

C. Paniculata. Lam. C. Strica, Lam, C.Sericea, L. [Swamp Dog^
wood.] These possess similar properties to the C. Florida, and arer
frequently substituted for it.

DIVISION II. M0N0PETAL0US EXOGENOUS PLANTS.

Order, Caprifoliaceae, [Honeysuckle Family.]
Symphoricarpus vul. M. [Indian Currant.] A small, elegant shruby
with dark red persistent berries. The root is tonic, astringent, and in?
small doses an active febrifuge; used for agues in Virginia ; for sy-
philis by the western tribes of Indians. [Raf.]

Lonicera sempervirens, Ait. [Coral Honeysuckle.] A beautiful
evergreen, climbing shrub, flowering in April, and in cultivation
throughout the summer; leaves and flowers bitterish, mucilaginous and
detersive'. A syrup used for sore throat, irritation of the lungs, etev
[Raf]

L. grata, Ait. [Honeysuckle.] Flowers fragrant ; medical proper-
lies similar to the last.

Samhucus Canadensis, L. [Elder.] The bark of the root is an ac-
tive hydrogogue cathartic, and in large doses emetic ; the flowers are
sudorific; the juice of the berries, diluted with water, forms an agree-
able laxative drink, in rheumatism, etc.

Viburnum prunifolium, L. [Black Haw.] Fruit sweetish, edible ;
Bark astringent, tonic.

V. acerifolium, L. V. der.tatum, L., and var. V. obovatum, T. and
G. Bark of many species smoked like tobacco by the Western tribes ;
used by the Indians and Shakers as a diuretic. [Raf.]

Triosteum angustifolium, L. [Feverwort.] Grows in fertile, shady
places. It probably has the same properties as T. perforatum, T. and
G. Grif. Med. Bot,

Order Rubiaceae, [Madder Family.]
A genus, with us, of herbaceous plants, with square stems and ver-
ticellate leaves.

Dr. Hale on the Medical Botany of Louisiana,

167

Galium aperine, L. [Bedstraw.] Diuretic, aperient and antiscor-
butic. [Porcher.]

G. asprellum, M. [Rough Bedstraw.] Diuretic.

G. uniflorum, M. [One flowered Bedstraw.] The root contains a
red coloring matter.

G. circEezans, M. [Wild Liquorice.] Demulcent, expectorant and
diuretic. The roots taste like liquorice. [Riddell.]

G. pilosum, Ait. [Hairy Bedstraw.] G. triflorum, M. [Three
flowered Bedstraw.] G. trifidum, L. [Small Clevers.] G. virgatum,
Nutt.

Sub-order, Cinchonaceae. [Cinchona Family.]
Cephalanthus occidentals, L. [Button-bush.] A shrub 2-15 feet
high ; grows on the margins of ponds, etc. ; very common. Bark of
the root in decoction used as a domestic remedy in intermittents. Be-
neficial in obstinate coughs. It was in use among the aborigines.

Mitchella repens, L. [Partridge-berry.] A beautiful little prostrate
evergreen plant, in shady woods, bearing fragrant white flowers, in
pairs, and scarlet berries, which it often retains throughout the win-
ter. Diuretic.

Spigelia Marilandica, L. [Carolina Pinkroot.] Pinkroot is a cer-
tain and powerful anthelmintic ; it possesses narcotic, and to some
extent, cathartic properties. Pinkroot deteriorates rapidly on keeping,
and should be used fresh ; fortunately, this may generally be done, as
the plant grows abundantly throughout the State. The infusion is the
best form of administration.

Order, Compositae. [Composite Family.]
This is one of the most natural and extensive orders of the vegetable
kingdom, consisting of one tenth of the known plants. It is readily
known by the flowers being collected into heads, and the stamens
united in a tube. In proportion to the vast number of species, the
useful ones are few. Their general characteristics are bitterness and
astringency, but their properties, often, vary widely.

Vernonia naveboracensis, Willd.; [Iron Weed] and several other spe-
cies, all possessing similar properties ; a bitter, combined with a re-
sinous principle ; a spirituous tincture is made of the root and used for
fevers, in Kentucky. [Raf.] Used against poisons, [Schoepf ] used
by the negroes of South Carolina in snake bite.

Elephantopus Caroliniana, Willd. [Elephant's Foot.] Fertile
soil.

E. tomentosa, L. Dry soil.

168

The New-Orleans Medical and Surgical Journal.

E. scaber, L. Flowers sept. Wet pine woods; properties very sim-
ilar to those of vernonia. A decoction of the leaves and roots of E*
scaber is given on the Malabar coast, in cases of dysuria [Ainslie] ;
and in Brazil, according to Martius, the root is used in intermittent
fevers.

The root of E. tomentosa is an Indian remedy for snake bite, and
has been employed in popular practice with apparent benefit.

Liatris elegans, Willd. L. squarrosa, Willd. L. accidota, Eng. and
Gr. L. pycnostachya, T. and G. L. scariosa, Willd. [Button Snake-
root.]

Several of these species are elegant plants ; the heads of purple flow-
ers are arranged on the simple stem, in long spikes, or racemes. The
root is a naked tuber, endued with a terebinthinale substance ; it has
an acrid, bitterish, pungent taste, and an aromatic odor. The active
qualities are wholly given out to alcohol. The Indians used the roots
as a diuretic ; stimulant, carminative and diaphoretic. [Riddell.] The
plants of this genus merit investigation at the hands of physicians.

L. odoratissima, M. [Vanilla leaf.] The leaves, when bruised,
or wilted, exhale a strong odor of vanilla, which, in a dry state, they
retain for many years. The leaves are frequently brought to market
in New Orleans, in a fresh state, by the Indians.

Eupatorium perfoliatum, L. [Boneset.] This is one of the most
valuable articles of our indigenous Materia Medica, being an efficacious
remedy in the treatment of diseases common in this country. It was
in use among the Choctaw and other Southern Indians, for the cure of
intermittent fevers. From them the early settlers derived a knowledge
of its virtues.

The remedial properties of Boneset are various ; it is tonic, diapho-
retic, emetic, and in large doses aperient ; as a tonic, it is well suited to
cases of dyspepsia, and want of tone in the system, requiring the use
of simple bitters ; for this purpose the infusion is the best form of ex-
hibition. In various forms of fever it is of considerable efficacy ; but
in intermittent?, its diaphoretic properties are of the greatest force ;
given in warm infusion, before the accession of the chill, it rarely fails
to prevent the paroxysm. In catarrh, its remedial powers are valua-
ble. As an emetic it is equal, but in no respects superior to Camo-
mile. As a cathartic it has been employed in bilious colic, accompa-
nied with obstinate constipation, in the dose of a tea spoonful of the
powder every half hour until a cathartic effect is produced.

More than a dozen other species of Eupatorium are indigenous to th©

Dr. Hale on the Medical Botany of Louisiana.

169

State, most of which, no doubt, possess similar properties to the
above.

Eupatorium purpureum, L. [Gravel-root.] This is a large, coarse,
weed-like plant, 10-12 feet high, with a purple, hollow stem, and large
leaves, disposed in whirls. Diuretic; used in diseases of the kidneys
and bladder. Dr. Eberlee asserts that catarrhal fevers are cured by
drinking a weak infusion of the leaves, on going to bed.

Conoclinum Ccelestinum, D. C. Flowers blue, Habit, and probably
medical properties similar to Boneset, with which it was formerly
classed.

Aster. [Starwort.] A numerous genus of rather ornamental plants,
chiefly interesting on account of their flowering late in autumn, when
most other flowers have disappeared. Several of them, as A. cordifo-
lius, A. punicens, etc., which have aromatic roots, are said to be anti-
spasmodic.

Erigeron Canadensis, L. [Canada Fleebane, Horseweed.] This
species of erigeron has an agreeable odor, and bitterish, acrid, somewhat
astringent taste. Among its constituents, according to Dr. De Puy,
are bitter extractive, tannic and gallic acid, and a volatile oil. Diuretic
tonic, and astringent. It has been found useful in dropsical complaints
and in diarrhoea. U. S. Disp.

E. divaricatus, M. A small, branching species, belonging to the
same subdivision of the genus as the last; and probably possesses sim-
ilar properties.

E. annuum, Pers. E. Bellidifolium, Muhl. E. quercifolium. E.ve-
nosum, T. and G. E. tenue, T. & G. The five last named species of
Fleebane are, no doubt, identical in their medical properties, and may,
therefore, be employed indifferently, one for another. When bruised
they have a peculiar, not unpleasant smell ; their taste is bitter and as-
tringent. The most striking property of these plants is their diuretic,
for which they have been long employed in domestic practice, and have
been found efficacious in the hands of regular practitioners. They
have been employed in diseases of the bladder and kidneys, in dropsy,
especially of children ; also in difficulty of urinating. They agree
well with the stomach, even when squills and digitalis are not tolerated.
They are diaphoretic and emenagogue, for which purpose they were
employed by the Indians. Two or three drops of the oil dissolved in
alcohol, have suddenly arrested hemorrhage. In chronic diarrhea also
it is beneficial. [Raf.]

Solidago. [Golden-rod.] An extensive genus of herbaceous, pe-

170 The New-Orleans Medical and Surgical Journal.

rennial plants. Flowers yellow, in terminal, axillary and frequently
recurved racemes. The general character is mild astringent, combined >
in one or two species, with some stimulating qualities, owing to the
presense of an essential oil. [Grif.]

Solidage, odora, Ait. [Sweet-scented Golden-rod.] Grows abun-
dantly in pine woods ; readily distinguished from all our other species
of golden-rod, — about thirty in number, — by its very agreeable odor,
resembling aniseed ; this is owing to the presence of an essential oil.
The oil is used to relieve nausea and vomiting, to allay pain from flatu-
lence, and also to correct the disagreeable taste of medicines, which it
is said effectually to do, even that of castor oil and laudanum. The
leaves and flowers are used in some portions of the country as a substi-
tute for tea.

S. sempervirens, L. [Evergreen Golden-rod.] Very efficacious in
the cure of wounds. [Mer. and De Lens]

Baccharis halimifolia, L. A large evergreen shrub, common near
the sea and lake shore ; less so in the interior of the State ; readily
distinguished by its very long white beard (papus). In general use in
South Carolina as a palliative, in consumption and cough. It is slightly
mucilaginous; a strong decoction of the root may be employed. The
bark is said to exude a gum so much resembling honey as to attract
bees. [Porcher.]

B. glomerifolia, Pers. Properties similar to the last.

Ecliptica erecta, L. Leaves dye the hair black. [Raf.]

Silphium laciniatum, L. [Turpentine Sunflower.] S. scaberimum.
S. astericum, L. These all exude a fine fragrant and bitterish gum,
resembling Frankinsense ; white or amber colored ; chewed by Indi-
ans to sweeten the breath and clean the teeth. [Raf.]

Parthenium integrifolium, L. The root is regarded by some as a
most valuable diuretic in ischuria. [Riddell.]

Iva fructescens, L. [Bastard Jesuits Bark.] A shrub, growing
near the sea and lake shore ; also at the salines, parish of Claiborne.
Bark, with the odor of Elderflowers, tonic ; the leaves may be pickled.
[Raf]

Ambrosia artimisifolia, L. [Ragweed.] Emollient and antiseptic.
It has been recently employed with success as a popular remedy for
;piles.

A. trifida, L. Long Prairie, Red River. Var. Palmata, New Or-
leans.

A plant has been noticed by Dr. Robertson, (American Journal Med.

Dr. Hale on the Medical Botany of Louisiana. 171

Science, XII. 382) which appears to be A. trifida, as highly beneficial
in arresting excessive salivation. [Grif.]

Xanthium strumarium, L. [Cockleburr.] Sobacrid, astringent and
diaphoretic ; used in scrofula, herpes and erysipelas. [Raf.]

Echinacea purpurea, Mcench. [Red Sunflower.] Root thick, very
pungent to the taste. Used in syphilis by the Mandans. [Raf.]

E. angustifolia, Nutt. [Black Sampson.]

Bidens chrysanthemoides, M. [Spanish-needle.] Three or four
other species. The seeds, boiled in water and strained, mixed with
honey, form a most excellent expectorant, in whooping cough and other
catarrhal affections. [Williams.]

Verbesina Virginica, L. [Virginian Crownbeard.] A valuable su-
dorific and depurative, of the Indian tribes. Root used in decoction.
[Raf.]

Helenium autumnale, L. [Sneeze-weed.] Grows in the Western
prairies and some other localities in this State. It has a bitter, slightly
pungent taste ; tonic and diaphoretic ; also a powerful errhine ; the
entire plant, in powder, possesses this property, but the flowers of the?
disk possess it in the highest degree.

H. quadridentatum, Ell. Abundant in the commons of New Orleans?
and others places.

H. tenufolium, Nutt. Grows on Red River ; abundant in the com-
mons of Alexandria. The two last possess the same properties as EL
autumnale.

Leptopoda brachypoda, T. and G. L. Helenium Perennial ; plants
resembling in habit and properties the genus Helenium.

Marata cotula, D. C. [May- weed, Dog Fennel.] Naturalized, iti
places. This plant has a strong and unpleasant smell, and a bitter,
acrid and nauseous taste. It is tonic, diaphoretic and emetic, closely
resembling chamomile in its effects, but is more unpleasant to the taste.
Externally it is an efficient and safe vesicant. According to Dr. Ashly,
bruised and applied in the form of poultice, it vesicates promptly, and
the blisters heal readily.

Guaphalium polycephalum. [Life-everlasting.] Possesses a slight
aromatic odor, and slightly bitter taste ; used as a domestic remedy in
the form of tea, in diseases of the chest and bowels, and in hemorrha-
gic affections. Externally it is applied in the way of fomentation, in
bruises and languid tumors.

G. purpureum, L. G. uliginosum, M. G. Plantagineum, Ell. All
these possess similar properties to G. polycephalum, and may be sub=

172

The New-Orleans Medical and Surgical Journal.

stituted for it iti most cases. The Guaphaliums are also used against
negro poisoning and rattlesnake bites. Indians, for a trifle allow them-
selves#to be bitten, and cure themselves at once. [Raf.]

Cacalia tuberosa, Nutt. C. ovata, Ell. C. lanceolata. [Wild Car-
oway.] Leaves glaucus ; all, more or less, emollient, like mallow.
[Raf.]

Senecie hieracifolia, M. [Fire-weed.] A large homely weed, in
newly cleared ground. The bruised herb is sometimes used externally,
to painful swellings and ulcers.

S. aureous, L. [Ragwort.] It is said by Schoepf to have been a
favorite remedy with the Indians. The juice of the plant in honey, or
the seeds in substance, are employed. [Porcher.]

Lactuca elongata, Muhl. [Wild Letuce.] Said to act as an ano-
dyne, and to produce a discharge by the kidneys and the skin, being sim-
ilar in its effects to L. virosa of Europe.

Nabalus albus, Hook. [Rattlesnake-root.] Used in dysentery and
to cure snake bites ; in the last case it is applied in the form of poul-
tice. [Raf.]

N. altissimus, Hook. [Gall of the Earth.] The root is excessively
bitter. Used as a tonic in domestic practice, in South Carolina.
[Porcher.]

Order, Lobeliaceae. [Lobelia Family.]
The plants of this order with us, are all herbaceous, yielding a milky,
acrid juice, and are all dangerous plants, belonging to the acro-narcotic
class of poisons.

Lobelia inflata, L. (Lobelia.) This is an unsightly weed-like plant,
growing in most parts of the United States. It has an unpleasant odor,
and an acrid, nauseous tast^ Dr, U. Proctor, (American Jour. Phar.).
found it to contain a peculiar principle, lobeline, lobelic acid, a fixed
oil, resin,, etc. Lobeline is a principle analogous to nicotine ; it is
semi fluid, of a light yellow color, and less specific gravity than water.
(Grif.) Lobelia imparts its active principles both to water and alco-
hol ; was known to the aborigines, and employed by them both in medi-
cine and the preparation for their great ceremonies. In small doses
lobelia acts as a diaphoretic and expectorant ; and in large doses as a
powerful and even dangerous emetic ; whilst in still larger quantities
its effects are those of an active acro-narcotic poison.

L. cardinal is, L, (Cardinal Flower.) A fine showy plant, with
bright scarlet flowers, growing in wet, shady places. Properties simi-
lar to the L. inflata, but probably less energetic.

Dr. Riddell's Microscopic Observations.,

L. syphatitia, L. Flowers, as in most of our species, blue. This
plant was in high repute among the Indians as a remedy for syphilis,
and at one time employed by physicians, but subsequent experience did
not confirm the statements in its favor, and it is at present neglected.
It is, however, an article of some activity, and might perhaps be found
beneficial in the same kind of cases in which L. inflata is found useful.
" Grows in Louisiana." (Riddell.)

The following native species also possess similar properties to the
L. inflata, and some of them are supposed to possess greater diapho-
retic and diuretic powers than that species :

L. pubala, M., resembles the last.

L. glandulosa, Walt. L. paludosa, Nutt. L. glabella, L. Claytonii, L.
[To be continued.]

V— SELECTED ITEMS OF MICROSCOPIC OBSERVATION.

Being in explanation cf eight Lithographic Plates relating to Animal cells, the
origin of capillary vessels, cause of the circulation of blood in animals, swarm-
ing in vegetable cells, microscopic pathology, and natural history,

BY J. L. RIDDELL. M. D.
Prof. Chemistry in Med. Dep. Univer. La.

{Continued from the July Number of this Journal.)

TAB. XV.

HISTOLOGY.

[1000 diameters, No. 143 excepted.]
Cellular structure of the tadpole.

143. Frog spawn ; ova found on the surface of a puddle of rain water, July 3d ;
presumed to be of the Hyla arborea, Lau. Natural size, and appearance. As ia
well known, it consists of a black central globule, surrounded by a gelatinous enve-
lope. The black globule detached, broken and examined over an inverted micros-
eope with Spencer's best objective, presented among many things worthy of note,
the following :

144, 145. Cells containing nuclei, nucleoli, etc.

146. Nucleolus, with its contents rendered visible by adding salt and vinegar.

147. Free cells, probably the same as the nuclei of Nos. 144, 145.

148. Immeasurably small black bodies, occurring in great abundance in some of
the cells, manifesting incessant and active molecular movements.

149. A cell, showing within it, exterior to the free nuclei, multitudes of the black

174 The New-Orleans Medical and Surgical Journal.

points (148) in a state of motion. [This was observed the 4th July, after the tail oi
the tadpole, from which it was obtained, had made its appearance.]

150. Larger cell and contents, far more rare than 144, 145, 149. [Seen July 3d,]

151. Superficial arrangement of the cells, in the tail, and skin of the body ; [seen
July 4] no interstitial spaces being apparent. Material for assimilation is evidently
supplied to these cells, by simple endosmcsis or imbibition.

152. 153. What I take to be embryonic blood, mostly on account of the color, and
because I can find nothing else more closely resembling blood corpuscles. The con-
tained nuclei or nucleoli, many in number and variable in size, down to the smallest
visible mote, all manifest a slight molecular movement. This was observed July 5,
when there was no circulation of blood visible, in the living parts accessible by the
microscope.

154, a, b, c. Undoubted blood corpuscles. Seen July 6.

155, a, b. Appearance of the same (154), after the addition of salt and vinegar
The composite nuclei are here rendered visible.

156. Ciliated cell. Seen July 5. Upon disintegrating by compression, a third
day tadpole, many corpuscles are set at liberty, which for twenty or thirty minutes
will keep up a spontaneous gyratory motion, revolving four or five times in a second,
at last gradually ceasing. Just before the motion finally ceases, cilia? can be seen,
which are previously and subsequently invisible. They are probably less than one
thirty thousandth of an inch in thickness, so that a moderate movement is necessary
to render them visible. I saw cilice on one side of the corpuscle as represented.

TAB. XVI.
[1000 diameters.']

HISTOLOGY, PHYSIOLOGY.

Origin of Capillary vessels, and Capillary circulation in the tadpole.

157. Cellular structure seen in the tail of a fourth day tadpole, [July 6] showing the
superficial cells more or less removed from each other, leaving intercellular spaces-
The adjacent deeper layers of cells being out of the focus, and not here representedj
are possessed of a similar mutual arrangement, there being interstitial spaces. This
is evidently the effect, in part, of growth, and in part of the intromission of a clear
fluid between the adjacent cell walls. Two days earlier' no intercellular spaces were
seen. Vide 151.

158, 159, 160. Incipient capillary vessels. The same tissue as the foregoing
(157), examined three days later, presents the intercellular spaces modified , as rep-
resented in these figures. It would seem that the tension or internal pressure of the
fluids of the growing tadpole, forces a clear liquid between the cells (157) ; that there
is thus a commencement of intercellular lymphatic circulation. This fluid probably
leaves a trace of plastic deposite in its path, and thus produces the curiously ramified
structures here represented. There are, in effect, vessels branching in all directions,
and communicating variously with each other (and doubtless also with the capillaries
carrying corpuscles subsequently), by channels often less than 50,000 of an inch in
thickness. In the enlarged portions, fine granular matter is ^pmetimes seen, as shown
ill 159. But no contained bodies, like proper cell nucleoli, or Schwann and Schlep,

Dr. Riddell\s Microscopic Observations.

175

•ien's cytoblasts, are at any time discoverable in these vessels, while they continue to
carry clear fluid.

Schwann, in his original and very able memoir of researches into the origin of
animal cells, is inclined to regard these structures as true cells. He describes them as
stellate cells, alleging that he occasionally saw what he supposed to be the nuclei
from which they were generated. Farther on I will advert to what I suppose misled
him. Carpenter, and other writers on physiology, have adopted Schwann's sugges-
tion in their attempt to account for the origin of the capillary vessels.

161, 162. Capillary vessels for the circulation of blood corpuscles.

a. Red corpuscles, appearing, as seen through the microscope, of a pale, brownish
yellow, moving through the capillary vessels, travelling really at the rate of an inch
in from five to fifteen minutes.

b. White blood corpuscle.

e. Red corpuscles which have become attached to the wall of the vessel. I have
often seen them run aground in this manner. Sometimes they get loose and resume
their voyage ; acquiring by the accident a more or less. attenuated caudal appendage.
Such must be the origin of the caudated corpuscles* so frequently seen in the blood
of the reptilia, and sometimes in the blood of man. In other instances they seem to
become permanently attached, forming, in effect, a sort of valve, which is obviously
adequate to act in the way of preventing regurgitation in the smaller capillaries.

f. Blood corpuscle attached along its whole length to the wall of the vessel ; proba-
bly mistaken by Schwann for a cytoblast.

c. d. Blood corpuscles as seen bending around angles. The red corpuscles are
remarkably flexible and plastic.

Origin of the Capillaries carrying blood corpuscles..

As the development and growth of the tissues proceed, the incipient vessels (158,
159, 160) containing and transporting a transparent fluid, seem to be distended by
the tension of their contents, and by the impetus of the blood corpuscles and serum.
This impetus is obviously derived from the action of the heart, and from the general
muscular movements. The corpuscles are forced into the mouths of the incipient
vessels. Some of them form valves, as in 161, e. The corpuscles, unable to return
by their path of entrance, are forced to open for themselves, through the ramifica-
tions of the incipient vessels (158, 159, 160) a new channel of circulation.

It is extremely probable, that the first single file of corpuscles, travelling as well
as subsequent ones, in the newly distended vessel, deposits upon the wall of the ves-
sel a portion of plastic material, which tends to give body, and limited thickness or
diameter to it: Hence the probable origin of the capillary vessels.

Motive power causing the circulation of the blood corpuscles.
In reference to the cause or causes of this capillary circulation of corpuscles in the
living tadpole, I entertain no doubt whatever in referring the phenomenon entirely to
muscular action. Because —

* Figures 117, 120, 123, in the July No. of N. O. Med. and Surg. Jour , p. 116,
represent caudated blood corpuscles,

176

The New-Orleans Medical and Surgical Journal.

1st. The action of the heart can be clearly seen by a half inch lens, and its pulsa-
tions timed.

2d. With different powers of the microscope the blood can be visibly traced ever*
to the extreme capillaries, manifesting, in a decreasing degree, 'the impulse of the
heart in quickened movement the whole way.

3d. When a stasis or obstruction occurs in the extreme capillaries, during the life
of the tadpole, the heart's impulse becomes palpably apparent, in a slight advance
and retreat of the corpuscles, synchronous with the contractions of that organ.

4th, General muscular action, by successively compressing and distending different
parts, must tend to give motion to the contained fluids ; and as valves occur, not only
in the veins, but even in the capillaries,* the (161, e) blood when made to move, is of
necessity mostly moved in its normal direction, from the arteries, through the capilla-
ries into the veins.

5th. Considering the normal velocity of blood moving in the capillaries, an inch in
eight or ten minutes, we should expect comparatively a very small obstruction, from
the friction of the moving fluid. Other things being equal, the resistance would be
nearly in a duplicate ratio to the velocity.

6th. Any degree of vital, endosmotic, capillary or chemical force, supposed to be
exerted between the fluid or the corpuscles on the one hand, and the walls of the con-
taining capillary vessels, or the subjacent tissues, on the other, could never be ex-
pected to cause the blood to move one way rather than the other ; for it would be a
force necessarily acting at right angles to the path of movement.

7th. The extreme capillaries seem to be mechanically passive,, suffering in rare
cases a distension synchronous with the pulsations of the heart, to an extent barely
appreciable \ usually giving transit to the blood, without observable change of form,
or dimensions.

Iam aware that opinions very different from what I have here expressed, respect-
ing the agencies here employed in circulating blood, have been lately advocated by
writers of great ability and- high standing. Their opinions seem to have been con-
fused, by comprising in the same point of view, two phenomena in every respect
wholly distinct, namely, the continuous circulation of organized corpuscles [blood],
which corpuscles may be seen, through tubes or vessels of measurable calibre ; a
purely vital phenomenon, only witnessed in animal beings that are at least large
enough to be visible to the naked eye ; and, a purely physical movement (not a con-
tinuous circulation) of fluids, in which no visible corpuscles are necessarily concerned.
Of this nature are imbibition, endosmosis and exosmosis, in animals and plants, and;
even in unorganized matter. Endosmotic imbibition at the rootlets, and exosmotic
evaporation from the leaves, contribute thus, efficiently, to the ascent of sap in trees.
And wherever organized cells, in a living condition, are in the active performance of
their accustomed functions, these physical agencies are seen to be subservient to the
processes of vitality, in supplying material and disposing of products.

In most of the processes of animal life, the oxidation of carbon takes place, requir-
ing the constant supply in some form of oxygen. The microscopic animalcule can
absorb directly enough of this agent from surrounding air or water, and for this pur-

* In some of the capillaries, no valves were observable. In these I have often seen,
the current of blood change its direction^ especially while the tadpole was dying.

Dr. Riddell's Microscopic Observations.

177

pose needs and possesses no corpuscular circulation. The aquatic worm, barely vis-
ible to the naked eye, will generally present, under the microscope, an alternate or
reciprocal row of corpuscles, from near one extremity of his body to tho other, then
back again, in the same simple channel. It is only in animal beings of a larger size,
where cell life is in progress at such profound depths from the surface as to preclude
the access of air by direct imbibition, that a complicated and special circulatory ap-
paratus becomes necessary.

TAB. XVII.

[1000 diameters, 183, 164 excepted.']

PHYSIOLOGY.

Molecular movements in vegetable cells.

163,164. Ciosterium Lunula, Ehr. Magnified 200 diameters. From the Meta-
rie Bayou, back of New Orleans, June 23. It is here associated with a species of
spirogyra. We have in this vicinity many species of Closteria. They are classed
with the Desmidis, a sub order of Alga?. The ciosterium consists of a single cell of
circular transverse section, without any external openings, and containing within an
organized green substance, denominated the endochrome. Many of the species oc-
casionally manifest, in a low degree, the power of self-movement, as evinced in slowly
changing position. Many observers have noticed near each extremity, a ball made
up of free granules, which incessantly move among themselves. The Closteria, in
my opinion, are truly of a vegetable nature, and such is the opinion of Meyen, of
Ralfs, who published a monograph of the Desmidia?, of Prof. Asa Gray and others,
in opposition to Ehrrenberg and Bailey, who incline to regard them as animals.

165. Ciosterium Lunula, Ehr. A representation of one extremity, on a scale of
1000 diameters.

a. A dense ball, consisting of a congeries of comparatively large, dark, free cor-
puscles, slowly moving among themselves, in that irregular wray denominated swarm-
ing. There is a clear spherical space around the ball.

bb' c c' Between the cell wall and the green endochrone, there is an open space,
along which a multitude of corpuscles, usually smaller than those at a, perform cer-
tain molecular movements. They seem anxious to approach the vicinity of the ball
a, and when about opposite to it, they then retreat, and may travel to the ball in the
other extremity. Usually, however, they march and countermarch a great number
of times between b, c, etc. ; so that they pass and repass each other, and sometimes
come for a moment in mutual contact.

e. Corpuscles mostly much smaller than the last, may be seen very activelv
swarming at e.

These curious and hitherto unaccountable movements, are perhaps of a vital na-
ture. They most likely contribute, in some way, to prepare for a subsequent pro-
creative process, the formation of a sporangium, and its highly elaborated contents ;
the analogue of the seed in the higher vegetables.

166, 167. Arrangement of hexagonal cells in the upper surface of a ray floret of
Dracopis amplexicaulis, Cass. Nat. Ord. Compositse. This plant has yellow florets

178 The New-Orleans Medical and Surgical Journal.

with a purple base ; it grows abundantly in this country. This drawing is designed
to illustrate the swarming movement of free molecules, which I have observed in the
petal cells of a great many different species of plants. It is unnecessary to enumer-
ate them. Under the proper circumstances, it must, I think, be universal. It is pro-
bably designed for the high elaboration and vitalization of vegetable substance, pre-
paratory to the procreative process finally shared by the pollen and the germ, which
results in the production of seed. In the examination of double flowers, as of the
rose, and the Impatiens balsamea, very little of this movement can be observed, and
I think none of it, in the absence of the stamens and pistils, by degeneration into
petals.

166. Shows the manner in which the yellow color of the petal is packed away in
a mullitude of ornamented cells or fiorulets.

167. Represents myriads of yellow* rounded vesicles, 1-60,000 of an inch in
diameter, as seen actively swarming, or moving in all directions. Here the cell con-
tents are supposed to be more advanced than in 166 ; these vesicles, now free, having
been the contents ef the ornamented cell.

In some flowers these vesicles are larger, in others much smaller ; and the same
remark is true of the ornamented cells which contain them. I have observed the
greatest abundance of the moving vesicles in the Composita?. The swarming is
precisely like that observed at e, 165, in the Closterium.

168. Side view of one of the hexagonal petal cells [taken near the base of the pe-
tal]. Longitudinal strise, like those so often seen on the cells of Closteria, exist upon
the surface of the cell. In this position the swarming is most satisfactorily seen.

Remark, The foregoing observations upon the swarming of vesicles in petal cells,
bring to light, in my opinion, an interesting analogy between the elaborate and beau-
tiful flowers of the field, and the obscure, flowerless algse. Similar swarming move-
ments are observable at certain periods in every algoid species which I have fairly
examined.

TAB. XVIII.
[1000 diameters.]

PATHOLOGY.

Structure of bronchial mucus.

Sputa of consumptive patients, and pulmonary tubercle.

169. Bronchial mucus not opake (March 9th) ; case of an obstinate cold ? A
corpuscle of two cells, contained vesicles manifesting molecular movements.

170. Mucus corpuscle, with moving nucleoli, as in 169, with which it was found;
a common form. From the distensible nature of such mucus cells, it is easy to com-
prehend how corpuscles like 169, 173, 174, and 93, 94, 95, Tab. X. could, by ex-
trinsic mechanical causes, be modified into the forms 170, 171, 172, and into the
forms 96, 97, 106, Tab. X.

171. Mucus corpuscle with 170, etc., with moving nucleoli.

* The coloring matter of the flower, whatever it may be, pertains to these vesi-
cles, when they swarm free.

Dr. Riddell's Microscopic Observations.

1?2. The fibrous structure of the same viscid mucus (169, 170, etc.) shown. The
fibres are probably produced by the elongation of rounded corpuscles.

173, 174. Mucus corpuscles, much condensed, from a sore throat? with a little
blood ; 173, nucleated corpuscle, with moving nucleoli ; 174, corpuscle with moving
nucleoli.

175. Outline of a blood corpuscle.

176, 177, 178, 179. Corpuscles mostly resembling in structure mucus corpuscles,
observed in the ropy, cream-colored, opake, odorless sputa, expectorated by a lady
aged 27, who has had phthisis six months. She is attended by Br. A. F. Axson, who in
this, and many other instances of disease, has kindly furnished me samples for exa-
mination. In none of these corpuscles were the nucleoli observed to move. It is
probable that most of them were mucus corpuscles, but so long retained in the lungs
and bronchia as to have lost their vitality These corpuscles were frequently entan-
gled in a fibrous substance like the fibrous part of 172 ; and with these could be seen
a large amount of amorphous, granular matter, [disintegrated corpuscles] similar to
182, 188, and a variety of minute algae (189, 190, 192, 193). Occasional epithelial
cells (183) were observable.

180, 181. Corpuscles resembling 177, 178, in the sputa of an Irishman, aged 40,
in the- Charity Hospital, under the treatment of Dr. C. Cummings, who brought the
sample for examination. This patient is far gone with chronic consumption. lie
expectorates more than a pint of ropy sputa daily. Some of these corpuscles show
moving nucleoli within. In others the contents are still. These sputa contained a
great abundance of minute algae of the forms 191, 192, 193, 194, and large corpus-
cles of a specific kind, 195.

183. Nucleated epithelial cells, observed in the sputa of Dr. Axson's case, (176,
etc.)

184, 185, 186. Corpuscles seen in a closed tubercle from the lungs. July 8th.
Dr. C. R. Nutt brought me a gray tubercle half an inch in diameter, dissected from
the lungs of a person who had died that morning in the Charity Hospital. The depo-
site seemed to be in the air cells, and its structure not unlike that of bronchial mu-
cus, after making allowance for compression, condensation and frequent distortion of
form, such as might be expected under the confined circumstances. No moving
molecules were observed in the tubercular contents, and none of the minute algae,
189 to 195, were seen.

187. Corpuscles from the tubercle (Dr. Nutt's case, 184, etc.) probably stinted in
size and deformed in shape, by mutual pressure and want of room. These forms cor-
respond to the tubercle globule of H. Lebert.

188. Disintegrated granular mass, with 187 ; the remains of disintegrated cor-
puscles ; similar to 182, observed in sputa. The degree of opacity in tubercle and
in expectorated matter, seems often to depend mainly upon the greater or less abun-
dance of these amorphous granular remains.

180

The Neic -Orleans Medical and Surgical Journal

TAB. XIX.

[1000 diameters.]
PATHOLOGY.

Alg& in the lungs,
Corpuscles in herpetic eruption.
Corpuscles in vaccine eruption.
Corpuscles from sanies in the uterus.

Algae in the lungs, in cases of pulmonary consumption.

189. Beaded Algoid filaments, (Vibriones?) very abundant in the sputa of the
cases examined. Dense masses are formed of it.

190. Algoid cells seen in the sputa, in the case under Dr. Axson's treatment,
(176, etc.)

191. Algoid cells, in the sputa of Dr. Cumming's case, [180] perhaps specifically
identical with 190.

192. Jointed algoid filament, seen abundant in the sputa of both eases. [176.
180.]

193. Oscillaria? Often met with in consumptive sputa [176, 180].

194. Oscillaria? Same as 193. Tufts of these were seen in Dr. Cumming's
case, in which the filaments were more or less invested with masses of spherical vesi-
cles, as shown in the figure.

195. Peculiar cell, more or less filled with vesicles of uniform size, larger than
those of 169, 170, 182, 188, 194, etc. This is probably an algoid body.

Remarks. — In no instance was any of these alga3 from the lungs observed to man-
ifest spontaneous movement. The oscillariaB were probably in the purely vegetable
condition mentioned in explanation of figures 76 to 8. [Number for January,
1852,]

These bodies were observable in the freshly expectorated sputa ; they must there-
fore have come from the lungs. Their germs were probably inhaled in the breath,
and developed in the lungs of these patients, because, from the existence of cavities,
or from other causes, the mucus remained an unduly long time in the lungs, after its
formation.

These bodies can probably have nothing to do with causing consumption ; yet,
when enough of observations shall have been made, it is more than possible that the
discovery of them in sputa will give to the physician the most important information
respecting the condition of the lungs.

Contents of herpetic pustules.
On the 15th June, Dr. Axon introduced to me a gentleman with herpetic pustules
[something like itch] upon his fingers. A pustule 1-10 of an inch in diameter waa
punctured, and the tolerably clear fluid examined. In it were found :

196. Delicate corpuscles, with irregular outline, and granular contents.

197. Granules grouped together in branching, irregular shapes.

Vaccine Jiuid examined.
The nearly clear ichorous fluid, running on the 9th day from a vaccina sore on the

TAB.M

TAB .XIX

Dr. R iddeli/s Microscopic j Observations.

1*1

arm of a healthy negro infant, showed [May 30th] nothing but the following :
198, 199. Polygonal cells, containing very minute granules.

200. Free granules or vesicles, single, double and associated, manifesting molecu-
lar movements.

I am not prepared to assert that these observations show any thing specific in the
vaccine fluid.

Sanies from the uterus.
May 31. Dr. D. Macgibbon brought me a fetid fluid, just taken by means of a
speculum from the os uteri of a lady upon whom he attended, and who was afflicted
with ulceration of the uterus. It had none of the viscidity of mucus. In it I ob-
served :

201 , 202. Corpuscles containing minute moving granules. Many similar granules
were free in the fluid, still keeping up the swarming movement.

903. Moving alga?, similar to those 1 have often seen in putrefying animal matter.

TAB. XX. .

[1000 diameters.]

PATHOLOGY.

Typhoid dejections. Menorrhagia, Abscess.
Alg£e, etc. in typhoid dejections.

July 13th, Dr. Axson brought me a phial of rice water looking fluid, the alvine
evacuation passed a short time previously, by a negro man, aged 38, who had been
six days ill of typhoid fever. He had been improving for 24 hours, under the use of
naptha. In this rather fetid fluid I observed :

204,205,206. Cuboidal masses of a binary algoid body, resembling, if not speci-
fically identical with, the Sarcina ventriculi, of Prof. Goodsir. [Vide Queckett's
Histology, page 21.] They are colorless, and have the power of moving very slowly.
It is observed in Queckett's Histology, that the Sarcina resembles closely the Go -
nium pectorale, Ehr., which occurs in stagnant waters. There exists abundantly in
the waters of Lake Pontchartrain, and the tributary swamps and bayous, a closely
similar organism, a few corpuscles of which I represent in the following figure :

207. Associated squares of a binary algoid body. Drawn June 10, 1851, from
samples found with Potamogeton gramineum, in Lake Pontchartrain. Prof. Bailey,
to whom I sent a copy of the drawing, pronounces it the Gonium glaucum, Ehr., or
the Merismopedia punctata, Meyen, which is synonymous.

This association of corpuscles moves very slowly, at about the rate of one inch in
twelve hours. It seems to direct itself at will occasionally, though its general course
is straight.

The movements of 205, etc., are not much more rapid, and are only rendered ap-
parent by the great magnifying power employed to inspect them.

208, 209, 210. Algoid bodies observed in the typhoid dejection before alluded to
211, 212. Corpuscles observed in the typhoid dejection.

913. Minute moving granules in the typhoid dejection.
214, 215. Moving algoid [?] filaments observed with the preceding,

182

The New-Orleans Medical and Surgical Journal.

Mennorhagia.

May 12th. Dr. Macgibbon gave me for examination a fresh sample of white and
very viscid mucus, removed by means of the speculum from the os uteri of a woman,
aged 28, suffering from mennorhagia. In it, besides a lew epithelial cells, I ob-
served :

216. Rounded corpuscles, resembling 174.

217. Corpuscles and mucus fibres, like 172.

218. I.one cells filled with oblong nucleoli or granules.

Pus from an Abscess.

July 12. Mr J. O. Magee, student in the Charity Hospital, brought me a sample
of pus, which had just been discharged by the use of the knife, from an ordinary
abscess in the neck of an hospital patient. It was yellowish and opaque. With the
microscope I found it to consist, so far as could be seen, wholly of corpuscles, like
those represented in 219, 220, and the ragged and granular debris of corpuscles, not
here shown, mixed with a little blood [221], the latter probably furnished by the inci-
sion. No molecular movements were observed.

219. Pus corpuscles from the abscess above mentioned.

220. Pus corpuscles partially disintegrated, with the preceding.

221. Outline of blood corpuscle with the pus.

TAB. XXI.
[1000 diameters, 225 excepted.]

NATURAL HISTORY.

Structure and habits of a species of Alga (Oscillaria, Bosc).
Oscillaria Aureliana, Riddell.

222. Outline of the most common dark green alga in the street gutters of New
Orleans, and in stagnant waters back of the city. The filaments are mostly very
many times larger in proportion than represented ; mostly straight, if free, rarely
slightly spiral. In the early stages of their filamentous growth, no movements are
discernible ; later, these filaments spontaneously move indifferently either end fore-
most, at the rate of near one inch in four hours, generally revolving at the same time
upon their longitudinal axis, from right to left, nearly five times in a minute.

223 shows their vesicular structure, and the transverse markings due to cell septa.
Some writers [Asa Gray, Bot. Text Book, p. 66] consider the Oscillariee as " single
elongated cells, without septa. Figure 226 shows the appearance produced in 222,
by first digesting in caustic potash, then boiling a short time in nitric acid ; the endo-
chrome tends to contract and become globular, leaving the cell septa perfectly appa-
rent.

224. Viewed with oblique light properly directed, very minute transverse striae
are visible, which pertain to the exterior coat, for they are visible in the empty end of
227, a broken filament. These striae are near 80,000 to the inch.

225. A single segment of the same, magnified 3000 diameters, showing the cross
strise [224] and also faint marginal projections. I have scarce a shade of doubt that

Dr. Riddell's Microscopic Observations. 183

the striae are produced by the projections ; and further, that these projections are of
the nature of moving ciliae, immeasurably small. I have often obscurely seen them
as represented. This must be the mechanism by which the alga moves.

226. Demonstrating the existence of septa in the Oscillaria. See 223.

227. End of a filament, supposed to have been broken off. The end, if growing
rapidly, is generally somewhat curved and of diminished size. The terminal cell of
a broken filament immediately rounds itself out, as shown ; while the containing
tube, so far as it is left empty, is usually somewhat contracted in thickness , evincing
thus some degree of elasticity.

The growth of these filaments, by elongation and subdivision of cells, occurs
every where intermediately, as well as at the ends. Intermediate growth is indicated
in this figure by the bulging out of the septa of a cell. The color in such places
is comparatively a lighter green.

Remarks. — These filaments, wholly invisible to the naked eye, abound in our gut-
ters, etc, in the form of a dark green slime. They [or a closely allied species] com-
municate an apple green hue to the whole body of the water of the large drainage
canals back of the city ; in which water they swim free, and in comparatively short
lengths. At length they ascend to the surface, where they form a green scum, or a
green paper -like stratum. In this condition they may become dry, by the evapora-
tion of their native pools, and without losing the vital principle. When mature and
nearly dry, the filaments are remarkably fragile, the cells generally separating, so
as to become short sections af a cylinder, in shape like cakes of cheese. In water,
these short segments manifest, like the filament which they before composed, what
appears to be a sort of animal vitality. Their subsequent development and transfor-
mations I propose to notice, so far as I have observed, in explanation of the next
plate.

TAB. XXII.
[1000 diameters.]

NATURAL HISTORY.

Transformations of Oscillaria Aureliana.

228. End view of a segment or single cell. [Vide Remarks under 227.]

229. The same developed to a larger size, having acquired one or two small red
irregalar vesicles. Its movements become now something like those of a leech. Its
contents are mostly deep green in color, vesicular and granular in structure ; exter-
nal openings none ; grows by endosmotic imbibition ; surface minutely [1-80,000 of
an inch] striated ; anterior extremity armed with a vibratile hair, very difficult to be
seen. [134.] The movements are 10 to 20 times as swift as the Oscillaria in its fila-
mentous form [222].

230,231, 232. Same as the preceding [229], as seen in action, and in different
positions. The movements appear to be under the control of volition.

233. More advanced stage of 229, as seen in a state of rest. Here well defined
comparatively large vesicles may be seen.

234. Same as 233 ; in a state of motion. The vibratile hair is here represented.
Remark. Botanists would call this being a zoospore. Somewhat similar beings

have been observed in many instances, as produced by different species of fresh water

184 The New-Orleans Medical and Surgical Journal.

algae. Considering that it lias been seen to produce a multitude of rounded cells-
[236, 237] which doubtless individually possess a germinative power, it would pro-
perly be termed a sporangium.

235. Mature sporangium, the final form of 228, 234. My attention was first
fairly called to this body, May 11th, 1852.. when riding out Bienville street, more than
a mile back of the city, I saw an intensely vivid green scum, upon shallow drying
pools of water by the way side. Upon examination I found it made up of these cor-
puscles, all of them sluggish, and some entirely inactive, dry and brittle. The water
below was filled with the same in the active condition [230, 234, etc]. The dry body,
235, would burst from the slightest cause, [and spontaneously, too, I believe], leaving
the free granular contents [236, 237] m a fit condition to be blown about by the
winds, or lifted into the air by the mere evaporation of water. [Vide figs. 54, 55, N
O. Med. and Surg. Jour, for Jan. 1852.

236, 237. Free cells ; granular contents of 235, the aerial form of Oscillaria Au-
reliana (222). It is not easy to observe well the contents of these cells. Indeed the
amount of contained visible matter is obviously very small, and when dry, they are
mostly filled with air. Hence, in proportion to their bulk, they must be exceedingly
light, and well fitted for transportation through the atmosphere.

Miasm. [A suggestion.]

For want of sufficient observations, I am unable to trace the history of the Oscil-
laria Aureliana, in a satisfactory manner, any further. 'I am sure, however, that last
year I collected from the air of this locality, and saw through the microscope, vesicu-
lar bodies resembling 236, 237. It is possible that these spores, inhaled into the lungs,
may quicken into parasitic life, taking on some form of alternate generation, of
which we are now ignorant, appearing perhaps as some cell, so slightly differing from
the appearance of the normal and ordinary cells, as to escape our observation ; yet
producing in the system an effect prejudicial to health. It is possible in short, that
in its aerial condition, this singular alga may be one of the kinds of miasm.

VI.— SOME OBSERVATIONS ON CEREBROSPINAL MENINGITIS,
IN ITS EPIDEMIC FORM.

BY R. F. TAYLOR, M. D., LOUISIANA.

Fortunately for mankind, the disease in relation to which we propose
to offer a few observations, Cerebro-Spinal Meningitis, as an epidemic,
occurs very seldom, and then, unlike most other epidemics, to a very
limited extent. In the outset of the malady, it is unquestionably much
more malignant than Asiatic Cholera in its worst form. But after pass-
ing through a few constitutions, the force of its virulence seerns to be
materially modified, rendering it much more amenable to treatment.

Dr. Taylor on Cerebrospinal Meningitis.

185

We find, so far back as the fourteenth century, the disease spoken of
by Prosper Alfin, under the name of Cephalitis CEgyptiaca, in an epi-
demic form, in France. Rumelius speaks of it in 1503 and 1517.
Ozanam mentions also the occurrence of an epidemic in Palermo and
the Sicilies, in 1588, which was described, and studied by Ph. In-
grabsia.

In modern times, we learn of the disease making its first appearance
in the Mediterranean, at Gibraltar, a place celebrated in the history of
epidemics. It was at this unfortunate spot that the Plague made its
debut upon the continent, destroying in its progress many millions of
human beings, as well as vast numbers of domestic animals. An in-
teresting account is given by M. Rollet of Nancy, (Bulletin de V Acad.
Roy. de Med., VIII. 43) and MM. Fauvre, Villar, ChafFaurd and Forget
in 1844. In the "Dublin Quarterly Journal of Medical Science, Au-
gust, 1846," an article may be found from the pen of Dr. Mayo, descrip-
tive of the disease as it occurred in Ireland.

The first appearance of the malady in the United States, so far as
we are informed, was mentioned by the author of this paper, then re-
sident in Whiteviile, Tennessee, and Dr. Hicks of Vicksburg, simulta-
neously, both papers appearing in the New Orleans Medical and Sur-
gical Journal, May, 1847. In January, 1848, the disease appeared in
New Orleans in its most malignant form. The able faculty of that
city, if we are correctly informed, were, at first, at a loss to locate
the disease, and still more to treat it with any considerable degree of
success.

The Second Regiment of Mississippi Rifles, en route for Mexico,
during their bivouac in New Orleans, January, 1848, suffered very se-
verely. Dr. Love, the Surgeon of the Regiment, remarks : " Six
months after our Regiment had entered the service, we had sustained
a loss of one hundred and sixty-seven by death, and one hundred and
thirty-four by discharge." This great mortality is certainly almost
unparalleled.

Dr. S. Ames of Montgomery, Alabama, in the New Orleans Medical
and Surgical Journal, November, 1848, describes the disease at great
length, and gives the microscopic examinations of a number of cases
occurring in his practice in the winter and spring of 1847 and 1848.
Since that period we hear of little being said in reference to the malady.
A few cases, however, appeared upon the plantation of Messrs. Turner
and Quitman, in Council Bend, on the Mississippi river, near Vicks-

186

The New-Orleans Medical and Surgical Journal.

burg. Those gentlemen lost seven likely men on the fourth day of the
attack. The most prompt and decisive treatment that could be devised
seemed to utterly fail in making the slightest impression upon the dis-
ease. Recently we learn of an epidemic, resembling Cholera, exist-
ing in Matagorda, and other portions of Texas. From the descriptions
given, we have no doubt of its being Cerebro-Spinal Meningitis.

According to our observations, founded upon microscopic observa-
tions, the disease occurs in two distinct forms — a point oj special im-
portance to be borne in mind. In the first, there are no signs of lesion
of the nervous centres ; no affection of sensation or motion, but all the
symptoms of Phlegmasia ; rigors, vertigo, agitation, slight delirium
and fever. The latter, however, is not always present. In the second
form, the mental faculties are greatly impaired, with total abolition of
the functions of sensation and motion. In this form we find, upon dis-
section, vascularity of the arachnoid, layers of plastic lymph, and puru-
lent matter covering the inner surface of the Pia Mater, with collections
of pus at the base of the brain. The cerebellum is most generally
softened, and pus is found along the vertebrse. These lesions, for the
most part, correspond with the observations of MM. Fauvre, Villar,
Chaffaurd and Forget.

We have said that the mortality in this disease was greater than that
of Cholera, and might have added, excelled only by that of the Plague,
the scourge of the Sultan's dominions. In the French epidemics, ac-
cording to the eminent authorities cited in the first part of this paper,
the calculations exceeded eighty per cent of the whole number. In the
Irish epidemic it was still greater, in the beginning of which aljnost
every case died. According to our observations, the mortality would
amount to at least seventy-five per cent ; a frightful commentary upon
the utility of the healing art.

In regard to the symptoms, as before remarked, we have in the first
form of the disease the ordinary signs of inflammation. Upon the out-
set of the attack the patient complains of difficulty in breathing, with
acute pain in the side and thoracic region. The bowels are generally
in a constipated condition ; exaltation of the cutaneous sensibility ;
countenance tetanic ; twitchings of the muscles, and involuntary starts.
Rose colored petechia? are often found in the clavicular regions, and
upon the surface of the body and upper extremities.

In the second form of the disease the symptoms are of the most for-
midable character. In the commencement of the epidemic most cases
are marked by deep collapse, as in Cholera. There is complete abo-

Dr. Taylor on Cerebro-Spinal Meningitis.

187

iition of the functions of sensation and motion. We remember the
case of a child, five years of age, previously in good health, who com-
plained of slight pain in the abdomen, became collapsed in less than
an hour, and died in four hours from the beginning of the attack.

In reference to the treatment of this inveterate malady, we have tried
all of the therapeutic agents recommended to combat inflammation, and
found them almost entirely useless. Bleeding, cupping the spine, pur-
gation, powerful counter- irritation, large doses of Calomel, alike seemed
to have little influence upon the progress of the disease.

In view of these facts, it occurred to us that large doses of Quinine
and Opium might be of service, and accordingly determined to test
their practical application. We were not then aware that the experi-
ence of the French practitioners had demonstrated Opium as the chief
remedy to be relied upon

When the collapse is deep, as in the second form of the disease be-
fore described, it is totally out of the question for any practitioner to
assert that remedies will be of the slightest service. Dissolution is
inevitable. It seems as though life had congregated itself in one
bright resplendent spot, in the hidden recesses of the nervous system, to
take its departure forever.

We administered Sulphate Quinine in ten grain doses every two
hours, with two grains Opium, or its equivalent of Sulphate Morphine,
and found the treatment highly beneficial. When an impression had
been made by these remedies, we usually administered afterwards 20
grains of Calomel combined with Comp. Ext. Col., so as to produce
full and free purgation. The latter remedy, in the commencement of
an attack, is never of the slightest service, according to our experience.
But after the free use of the remedies above indicated, it is of much
value.

Precisely in what manner these remedies act, — their modus operandi
in restoring the diseased tissues to a normal state, — we are at a loss to
conjecture. Absolutely certain it is, that all the cases we ever saw
restored to health were accomplished by the liberal use of these reme-
dies. Probably their stimulant and sedative effect, in some mysterious
manner, inexplicable, combine to overthrow the disease, and restore the
tissues to a normal state.

July, 1852.

188 The New -Orleans Medical and Surgical Journal.

¥11. — ON THE USE OF SALINES AND OPIATES IN DYSENTERY,

BY F. E. GORDON, M. D., ALABAMA.

Having made a report to the Alabama State Medical Association, by
appointment, on the diseases of Marion, which was lost through the
illness and absence of Dr. Jackson, its late Treasurer, I herewith sub-
mit the following remarks on the use of Salines and Opiates in Dysen-
tery.

This disease prevailed here as an epidemic during the spring and
summer of 1851, and gave rise to great diversity of opinion and treat-
ment. This is not strange, as its pathology and management have been,
for more than two hundred years, disputed points amongst the ablest
medical writers. Chisholm, and James Johnson more particularly,
contended " that the liver itself forms the primary seat of the disease
in every instance," and hence urged the use of mercurials even to pty-
alism, while the more venerable opinion of Sydenham, which locates
it in the larger intestines, is more generally received in this day ; and
hence a revival of his practice is likely to ensue, if it may not be said
to have done so already. With the exception of blood-letting, Syden-
ham's plan of daily purgation, followed by his own potent laudanum at
night, is not easily improved upon. That he would have abandoned
bleeding, had he lived to this day, (to say nothing of this climate) his
great practical sagacity and the example of his able successors in Lon-
don, warrant us in saying.

Watson contends that the sheathing of the lancet has been the result
of Cholera, which, since 1832, has modified the character of diseases,
and many eminent physicians on this side of the Atlantic equally ig-
nore the abstraction of blood, though accounting for its inapplicability
in different ways.

From a glance at the various reports made to the Alabama Associa-
tion, which, though conflicting in many respects, generally assign a
greater mortality to this disease, we would be disposed to set down our
epidemic as very mild. Indeed we think fever did not make its ap-
pearance in the onset of an attack oftener than once in ten cases. We
are admonished, however, that in the beginning of the epidemic the
disease did prove fatal in many cases ; not, however, from its ma-
lignancy, but, as we think, from the inefficiency of the practice by
which it was met. Such as died were literally worn out by the exces-
sively frequent and painful discharges, giving rise to irritative fever
and emaciation- Ulceration, we are satisfied, did not occur once in
three hundred properly treated cases-

Dr. Gordon on Salines and Opiates in Dysentery. 189

Our attention was first directed to the value of Salines and Opiates
in Dysentery, by an article in the Charleston Medical Journal for July,
1848, "on the comparative efficacy of certain medicines in the treat-
ment of Dysentery and other intestinal Fluxes of hot climates."

Dr. Papillaud, the author of this paper, made his observations in a
province of Brazil, in twenty-nine degrees of South latitude, and found
the usual plan of treatment adopted in Paris with success, to fail en-
tirely in this warm region-

"He experimented with castor oil, ipecacuanha, calomel, sulphate of
soda ; of the vegetable astringents, he tried rhatany and simarouba; of
the mineral astringents, lime, acetate of lead, alum and nitrate of sil-
ver ; of narcotics, extract of opium and sulphate of morphia ; from the
results of these experiments he determined to abide by sulphate of soda
and opium, the effects of the other medicines being variable and uncer-
tain." He says, " The English practice of calomel and castor oil is
very unsuccessful." "Sulphate of soda, he thinks, deserves the praise
it received from Bretonneau and Trousseau, acting energetically and
most rapidly. One or two drachms dissolved in a small quantity of ve-
hicle, and given in divided doses, usually arrest a dysentery in twelve,
twenty-four, or forty-eight hours at the longest." He says, "Inflamma-
tion once considered a cause, is only one form, alteration of secretion
another."

" The indications for local bleeding are very rare ; that for general
bleeding only as an exception." "Opium he considers equal to sulphate
of soda, and together they formed one of the most efficacious combina-
tions."

My first trial with this remedy was soon after its publication, and
proved highly satisfactory. In a few sporadic cases I continued to use
it with success. It was not, however, until the period referred to above,
viz., the spring of 1851, that I had an opportunity of witnessing its
effects on a large scale. Insensibly I fell into using Seidlitz Powders
amongst my white patients, as being more agreeable, and finding free
purgation to relieve both tormina and tenesmus, for about six hours I
usually followed it up by a dose of morphine. The fractional doses of
neutral salts and morphia were then resumed.

It was remarkable that in some cases, where hypercatharsis had
been induced, (the patient in one instance taking one powder every
half hour until eight were consumed) the recovery was most prompt.

Generally, when much opium had not been previously taken, from
two to four Seidlitz Powders at half hour intervals, freely evacuated
the bowels.

190 The New-Orleans Medical and Surgical Journal.

As regards pathology, I do not think inflammation of the mucous
membrane of the colon so much as engorgement of it, can be predicated
of a disease so easily relieved by a serous drain from the bowels, and
so often independent of fever. Whether the neutral salts act also as a
" local modifier" on the mucous membrane, according to the French
view of this subject, or as a " sedative" I am unable to say.

In order to establish the claims of this method of treatment, and to
vindicate it from the charge of empiricism, I subjoin reports from two
of our most intelligent and respectable physicians. Dr. England
says —

" Enclosed you find a list of cases of Dysentery that came under my care
during the present year, up to date, l5th August, 1851. It comprises all ages,
from infancy up to advanced age. All were subjected to the saline treatment
except two in January, which were treated by mercury and opium, and but
one death occurred among them. This was a case of unusual severity, first
seen thirty-six hours after being attacked, yet under the use of Salines the
Dysentery gradually yielded, so that in three days only slight sanguinolent dis-
charges occasionally recurred, and these subsided entirely forty-eight hours or
more before death, which occurred from nervous exhaustion, following the ex-
cessive excitement of the system. There were many other cases (where a sin-
gle prescription relieved the Dysentery) that required no visiting or attention,
of which I made no note."

" P. S. In addition to the above, there occurred thirty-five cases during the
spring and summer in the Judson Institute, which did not come under my im-
mediate care, yet were treated with salines according to my directions — all of
which recovered."

Here follows the table referred to by Dr. England :

Months.

Cases.

Recoveries.

Deaths,

January,

February,

March,

April,

May,

June,
July,

August,

Total

Under date of August 12th, 1851, Dr. Bryant encloses me the fol-
lowing statement, arranged in a tabular form. He remarks : Agree-
able to your request I send you the above list of cases of Dysentery,
treated by myself during the present year/'

Dr. Gordon on Salines and Opiates in Dysentery, 191

Dys.

Cured.

Died.

Adults over 14.

Children under 14.

Total.

March 2,

April 12,'

May 22,

June 24,

July 14,

August 8,

I have Dr. Bryant's authority for saying, that with the exception of a
single case, otherwise treated, these were all managed, with the highest
degree of satisfaction to himself, by the use of Salines and Opiates. In
the latter part of the epidemic he sometimes used Sup. Tart. Potass in
the more protracted cases, with decided benefit.

These gentlemen here cited will bear me out in saying, that Calomel
given to relieve the portal circulation excites a free gush of bile, which
is, to use Dr. Johnson's language, like so much boiling lead, throws the
irritable intestines into painful contortions, and then the tormina and
tenesmus are intolerable ;" and hence, like myself, they abandoned its
use for the Salines, which produced a gentle action on the liver and
copious discharges from the bowels, quieting for a time all distress like
a charm. The bile in these discharges was blunted by the quantity of
fluid with which it was mingled.

In a report made to the Alabama State Association, at their last
meeting, and published in their minutes, by Dr. F. A. Bates of Ma-
rion, we find the following remarks in reference to the treatment of
Dysentery, as it appeared in 1851 — the same epidemic of which we
have been treating :

" As might be supposed in a disease which appeared so suddenly, and with
which there was so little acquaintance, a great many remedies were suggested.
The virtues of almost every therapeutic agent were discussed as to its applica-
bility ; specifics sprung up like magic and magically wrought wonders ; every
family had its infallible curative at first, but after a while its charm ceased ;
quacks vended their never failing potions of drastic purgatives, with the assu-
rance that they never failed. A physician even, most potent to save, condes-
cended to prescribe, through the village journal, to whole communities at a
dash, a sovereign specific, viz : Seidlitz Powders, ad libitum, and guarantee a
cure by dinnertime, from their peculiar sedative effects. We do not believe in
specifics in the treatment of disease, and consequently must be pardoned for
not using them as such ; but we firmly believe in the therapeutic application of
many remedies in the same diseases, that others use as specifics."

Again —

" I am fully sensible that local depletion by cupping, and the depletive influ-
ences of cathartics, jars the nerves of some over-sensitive practitioners, who
have found a sedative principle in the operations of a dose of salts, but still they
are just as effective as ever when judiciously applied."

19*2 7%e New-Orleans Medical and Surgical JoumaL

I have quoted literally, as I do not wish to be held responsible for the
gentleman's grammatical construction.

It is remarkable in these two paragraphs that a cunning attempt is
made to couple the well-proven practice of a physician, with the nos-
trums of charlatans, and that he is not named in the report, lest it
might interfere with its reception. It is not pleasant to be lectured on
professional propriety by one who is likely to become notorious for his
breaches of it, nor to be held up as maintaining views just the oppo-
site of our own ; but we shall continue always to discountenance a
panic, and contribute to our fellow citizens and medical friends, both
publicly and privately, our " mite" of aid. That these remarks ema-
nate from ill-nature and pique is easily proven by the fact, that we are
charged in one passage as giving Seidlitz Powders ad libitum to whole
communities, and in the other as having our nerves jarred by " the
depletive influences of cathartics." Dr. B. further says, " Of forty-
eight cases that came under the treatment above specified, five proved
fatal, and three ran into the ulcerative stage and recovered."

We endeavored last summer, when the reports of the other physi-
cians were made, to draw from him this simple statement. We see
now that his whole year's experience is little more than half of theirs
in seven months. Further, will the gentleman deny, that commencing
the treatment of this epidemic with the most decided objections to Sa-
lines, he was forced into using them at the hazard of losing his prac-
tice ? Again, will he tell us what proportion of the five deaths re-
sulted before his use of Salines ? Perhaps after all they proved a
sedative to his conscience*

We protest against any implication by which the Saline and Opiate
practice is to lose its well-won laurels. It is well established in the
affections of nearly every household in this town, and has justified our
most sanguine expectations. We think we may safely say, that out of
about five hundred cases treated in Marion, and the country lying within
ten miles of it, after this mode, not more than four have proved fatal.
Mercury in Secondary Syphilis, and Quinine in Intermittents, though
we dare not call them "specifics," lest we "jar the over-sensitive
nerves" of the Doctor, are the only remedies in given diseases that acl
with more certainty and success.

Dr. Fugate on Tetanus.

VIII. PRACTICAL OBSERVATIONS ON TETANUS.

BY V. H. FUGATE, M. D. OF MISS.

A Hester, M. D.

Dear Sir — In the July No. for 1852 of your Journal, on page 87, I
notice the following remark : " We are rather disposed to give the cre-
dit of the cure to the judicious regimen adopted by the physician, and
to the lapse of time — it being well understood that this formidable dis-
ease is but little influenced by the most enlightened medication," etc.
From the above remark 1 am induced to ask your indulgence while I
detail a few cases (from my scrap-book) of Traumatic Tetanus, that
have occurred in my practice.

First. Negro boy, aged about 15 years, had the balls of his first
and second finger slightly split with the teeth of the gin-saw. No in-
convenience resulted until the sixth day, when he was violently attacked
with painful muscular rigidity and tetanic spasm of a general character,
as I learned from his master.

Saw him on the seventh day (at night) after the accident ; found him
perfectly inflexible at every joint ; could bend no joint ; pulse quick-
ened ; surface warm ; wounds on the fingers healed and dry ; spasms
frequent and severe, returning as often as one per minute, when undis-
turbed, though the slightest touch, the softest breeze, the least noise
induced the spasms at any instant, always accompanied with a fearful
and suppressed scream — his jaws being firmly locked. I applied a
blister to the ends of his fingers ; a batch of carded cotton from the
nape to the sacrum, wet with turpentine, to which I applied a lighted
torch, blistering him the whole length of the spine in an instant ; gave
him as much as a grain of Morphine, and ordered that as much good
French brandy as he could be induced to swallow should be forced down
him, with one grain of Morphine every hour, until some change ob-
tained.

On my arrival next morning, twelve hours from the time I left him,
no change had taken place, except that I could bend his knees slightly;
the spasms less violent, though quite as frequent. He had taken twelve
grains of morphine, and more than a pint of brandy. I now ordered
that the brandy and Morphine be continued night and day, with the ad-
dition of 20 grains of Quinine three times a day, dissolved in the brandy,
and that all the strong beef tea that he could swallow or retain by in-
jection, be allowed him.

On my next visit the ensuing day, I was astonished at the amount of
xMorphine and brandy consumed, and rejoiced to find an abatement of
all the symptoms. I continued this course for four day?, without any

194

The New-Orleans Medical and Surgical Journal.

variation, except as the symptoms continued to abate, the amount of
dose was correspondingly diminished, and the time between doses in-
creased.

I neglected to mention, that on the second day, after I saw him, he
drank a quart of brandy. I saw him three days after almost entirely
relieved ; dismissed him ; brandy and Morphine were continued three
times a day for several days, however. The boy recovered rapidly.

2d Case. Negro woman, aged 50, fell in the fire and burnt her
hand. When the ulcer was quite healed she took general tetanus, as-
suming on the second day Opisthotonos. The spasms were violent,
frequent and general ; jaws so locked that I had difficulty in getting her
to swallow any thing. I treated her alone with whiskey, Morphine,
laudanum and beef tea, as in the former case, that is, forcing down as
much as possible. She recovered in two weeks and three days.

Case 2d. Child, aged 11 years. Clothes caught on fire, burning
nearly the whole surface ; two weeks after the ulcers nearly healed,
tetanic spasms made their appearance.

I saw her seven days after I had dismissed the treatment of her burns,
in the most aggravated form of general tetanus, truly distressing, from
her emaciated condition. I put her under the influence of Chloroform,
which lasted half an hour. I then gave her a large dose of Morphine,
ordering her to have as much brandy and Morphine as she could bear
or swallow.

I repeated the Chloroform next morning, with entire relaxation as
before, which, however, did not last long, the spasms returning in an
hour, though much milder at first, and gradually increasing in severity
and frequency.

After this I continued as before to prescribe brandy, Morphine and
Quinine, with the most nutritious diet, for five days. Pronounced her
cured.

Case 4:th. Negro boy, frost bit toes. Ulcers became dry ; Tetanus
supervened.

I saw him four days after he had spasms first ; could bend no joint ;
took him by the head and set him up on end like a log ; could not get
one drop of any thing down him ; having, when undisturbed, two spasms
per minute.

I gave him an enema of Chloroform and Camphor, and presently
applied the Chloroform sponge to his nostrils, containing 3 ii, gradually
approaching it nearer and nearer, until I embraced his mouth and nose
with the sponge ; in three minutes he was as flexible as a string, and

Dr. Cartwright on the Philosophy of the Negro Constitution . 1 95

breathing stertorously. This condition continued five minutes, when
on puncturing his ear he opened his eyes. J gave him two grains of
Morphine in this relaxed condition. The spasms returned slightly dur-
ing the day.

Next morning put him under the influence of Chloroform again ; con-
tinued Morphine and brandy several days, as in the former cases ; he
recovered rapidly.

I have treated several others in the same way. What say you ?

Answer — -Mayhap the cases recovered in spite of the Doctor's heroic
doses. Ed.

IX.— PHILOSOPHY OF THE NEGRO CONSTITUTION,

Elicited by questions propounded by Dr. C. R. Hall of Torquay, England,
through Professor Jackson, of Massachusetts Medical College, Boston, to SamL
A. Cartwright, M., D., New Orleans.

To Prof. Jackson, Boston :

Dear Sir — The paper of mine, alluded to by your London correspon-
dent, Dr. Hall, which he saw in the medical work you mention, is not,
as he supposes, " The Report on the diseases and physical peculiarities
of the Negro race" the Physicians of Louisiana, in convention assem-
bled, appointed me to make ; but only some additional observations
intended for students and those persons whose want of knowledge of
Comparative Anatomy prevented them from understanding the Report.
The appendix, intended for students, was published in the Charleston
(South Carolina) Medical Journal, and also in the work you mention,
under the caption of the original Report to the Medical Convention, and
the Report itself was omitted by the editors of those works under the
erroneous impression, that the appendix for students contained the sub-
stance of that paper ; whereas it does so only in the sense that the
four first rules contain the substance of the arithmetic. No wonder
your intelligent correspondent should not find, in the appendix of the
report, the information he was seeking, and hence the questions he asks
you to refer to me for solution. I herewith beg leave to send you a
copy of the " Report on the diseases and physical peculiarities of the
Negro race" which the Louisiana Physicians appointed me to make to
the State Medical Society. In that paper your correspondent will find
most of the questions he asks already answered.

I thank you for the opportunity thus afforded me of supplying an
omission in the Southern works above alluded to, of a paper, very im-
perfect and defective, it is true, yet embodying in a small space the re-

196

The New-Orleans Medical and Surgical Journal,

suits of the experience and observation of a Southern practitioner, ex-
tending through a period of active service of a third of a century's du-
ration, and which had the honor to meet with the approbation of the
Physicians generally of the South. To the few questions not answered
therein I propose to reply, and at the same time to extend my remarks
on that branch of the subject more directly connected with the particu-
lar object of your correspondent's investigations.

To the question, " Is not Phthisis very common among the slaves
of the slave States and unknown among the native Africans at home ?"
I reply in the negative, that Phthisis, so far from being common among
the slaves of the slave States, is very seldom met with. As to the na-
tive Africans at home, little or nothing is known of their diseases. They
have no science or literature among them, and never had. The word
Consumption, is applied to two very different diseases among negroes.
The Cachexia Africana, Dirt-eating of the English, and Mai d'Estomac
of the French, commonly called Negro Consumption, is a very different
malady from Phthisis Pulmonalis, properly so called. The Cachexia
Africana, like other spanoemic states of the system, may run into Phthi-
sis, or become complicated with it. Dr. Hall asks in what does the
peculiarity of Negro Consumption consist ? It consists in being an
anoematosis and not a tuberculosis. Not having seen my Report, he
may have inferred that it was a tubercular disease—whereas it is an
erythism of mind connected with spanaemia. Negroes, however, are
sometimes, though rarely, affected with tubercula pulmonum, or Phthi-
sis, properly so called, which has some peculiarities. With them it
is more palpably a secondary disease than it appears to be among white
people. European Physicians are just beginning to see and acknow-
ledge the truth taught by our Rush in the last century, that what is
called Phthisis Pulmonalis is not a primary, but a secondary disease ;
the tubercles of the lungs not being a cause, but an effect of the pri-
mary or original vice of blood origin, or as he called it, general debil-
ity. For half a century the attention of the medical profession has
been directed to the special and ultimate results of Pthisis, instead of
the primary condition of the system causing the formation of the tuber-
cles. The new knowledge, derived from the stethoscope, by detecting
those abnormal deposits of abortive nutrition, called tubercules, has
been received for more than its worth, and has greatly served to keep
up the delusion of treating effects instead of causes. The tubercular
deposits, revealed by auscultation, are not only the effects of abortive
nutrition, but the latter is itself the effect of some derangement in the
digestive and respiratory functions, vitiating the nutritive fluids, and

Dr. Cartwright on the Philosophy of the Negro Constitution. 197

producing what Rush called general debility. The defect in the respi-
ratory organs arises from the fact, long overlooked, that in a great many
persons, particularly the Anglo-Saxons, the lungs are inadequate to the
task of depurating the superabundant blood, which is thrown upon them
at the age of maturity, unless aided by an occasional blood letting, ac-
tive and abundant exercise of the muscles in the open air, and a nutri-
tious diet, as advised by the American Hippocrates, Benjamin Rush.
White children sometimes have Phthisis, but here, as every where,
it is a rare complaint before maturity (twenty-one in the male and
eighteen in the female). The lymphatic and nervous temperament pre-
dominating until then, secures them against this fell destroyer of the
master race of men. Phthisis is, par excellence, a disease of the san-
guineous temperament, fair complexion, red or flaxen hair, blue eyes,
large blood vessels and a bony encasement too small to admit the full
and free expansion of the lungs, enlarged by the superabundant blood,
which is determined to those organs during that first half score of years
immediately succeeding puberty. Well-formed chests offer no impedi-
ment to its inroads, if the volume of blood be out of proportion to the
expansibility and capacity of the pulmonary organs. Hence it is most
apt to occur precisely at, and immediately following, that period of life
known as matureness, when the sanguineous system becomes fully de-
veloped and gains the mastery, so to speak, over the lymphatic and
nervous systems. With negroes, the sanguineous never gains the
mastery over the lymphatic and nervous systems. Their digestive
powers, like children, are strong, and their secretions and excretions
copious, excepting the urine, which is rather scant. At the age of ma-
turity they do not become dyspeptic and feeble with softening and at-
tenuation of the muscles, as among those white people suffering the
ills of a defective system of physical education, and a want of a whole-
some, nutritious diet.

Your correspondent asks, " Do the slaves consume much sugar, or
take rum in intoxicating quantities V

They do not consume much sugar, but are occasionally supplied with
molasses. Their diet consists principally of pickled pork and corn
bread, rice, hominy, beans, peas, potatoes, yams, pumpkins and turnips,
Soups, tea, coffee and slops, are seldom used by those in health, and
they object to all such articles of diet as making them weak. They
prefer the fattest pork to the lean. In the Atlantic States salted fish is
substituted for or alternated with pork— the shad, mackerel and herring,
principally the latter. In Cuba pickled beef is used, but they prefer
pork, Their diet is of the most nutritious kind, and they will not labor

193

The New-Orleans Medical and Surgical Journal,

with much effect on any other than a strong, rich diet. With very few
exceptions, they do not take rum or other intoxicating drinks, except as
a medicine, or in holiday times. Something equivalent to the " Maine
Liquor Law" (which you can explain to your correspondent,) has long
been in practical operation on all well regulated Southern plantations,
The experience of two centuries testifies to the advantages of restrain-
ing the black population, by arbitrary power, from the free use of in-
toxicating poisons. Man has no better natural right to poison himself or
his neighbor, than to maim, wound or kill himself or his neighbor. In
regard to intoxicating drinks, the negroes of the South are under wiser
laws than any other people in the Union—those of Maine excepted.
But Ihese wise unwritten laws do not so well protect those negroes
who reside in or near towns and villages, and are not under proper dis-
cipline. The Melanic race have a much stronger propensity to indulge
in the intemperate use of ardent spirits than white people. They appear
to have a natural fondness for alcoholic drinks and tobacco. They need
no schooling, as the fair skin races do, to acquire a fondness for either.
Nearly all chew tobacco or smoke, and are not sickened and disgusted
with the taste of that weed as white men always are when they first
begin to use it. As an instance of their natural love for ardent spirits,
I was called to a number of negro children, who found a bottle of whis-
key under a bed, and drank it all without dilution, although it was the
first they had ever tasted. It contained arsenic, and had been
placed where they found it by the father of some of the children, with
a view of poisoning a supposed enemy. But with that want of fore-
thought, so characteristic of the negro race, he did not think of the
greater probability of his own children finding and drinking the poison
than the enemy he intended it for.

"I am asked, li If I have determined by my own observation the facts
in regard to the darker color of the secretions, the flesh, the membranes
and the blood of the negro than the white man—or is the statement made
on the authority of others ?"

The statement is made on the authority of some of the most distin-
guished anatomists and physiologists of the last century, confirmed by
my own repeated observations. The authorities to which I particularly
refer are Malpighi, Stubner, Mackel, Pechlin, Albinus, Soemmering,
Verey and Ebel. Almost every year of my professional life, except a
few years when abroad, I have made post mortem examinations of ne-
groes, who have died of various diseases, and I have invariably found
the darker color pervading the flesh and the membranes to be very evi-

Dr. Cart weight on the Philosophy of the Negro Constitution. 199

dent in all those who died of acute diseases. Chronic ailments have a
tendency to destroy the coloring matter, and generally cause the mu-
cous surfaces to be paler and whiter than in the white race.

I now come to the main and important question — the 'last of the se-
ries, and the most important of all, viz: " How is it ascertained that
negroes consume less oxygen than white people V

I answer, by the spirometer. I have delayed my reply to make some
further experiments on this branch of the subject. The result is, that
the expansibility of the lungs is considerably less in the black than the
white race of similar size, age and habit. A white boy expelled from
his lungs a larger volume of air than a negro half a head taller and
three inches larger around the chest. The deficiency in the negro may
be safely estimated at 20 per cent, according to a number of observa-
tions I have made at different times. Thus, 174 being the mean bulk
of air receivable by the lungs of a white person of five feet in height,
140 cubic inches are given out by a negro of the same stature. It
must be remembered, however, that great variations occur in the bulk
of air which can be expelled from the chest, depending much upon the
age, size, health and habits of each individual. But, as a general rule,
it may be safely stated, that a white man, of the same age and size,
who has been bred to labor, is, in comparison to the negro, extra capa-
cious. To judge the negro by spirometrical observations made on the
white man, would indicate,, in the former, a morbid condition, when
none existed. But I am free to confess that this is a subject open to
further observations. My estimate may be under or over the exact
difference of the capacity of the two races for the consumption of oxy-
gen.

The question is also answered anatomically, by the comparatively
larger size of the liver, and the smaller size of the lungs ; and physiolo-
gically, by the roule the liver performs in the negro's ceconomy being
greater, and that of the lungs and kidneys less, than in the white man.
But I have not the honor to be the first to call attention to the difference
in the pulmonary apparatus of the negro and the white man, and to the
fact of the deficiency in the renal secretion. The honor is due to Tho-
mas Jefferson, the third President of the United States. In his Notes
on Virginia, Mr. Jefferson suggested that there was a difference in the
pulmonary apparatus of negroes, and that they do not extricate as much
caloric from the air by respiration, and consequently consume less oxy-
gen. He also called attention to the fact of the defective action of the
kidneys. He remarks, " To our reproach be it said, that although the
negro race has been under our eye for a century and a half, it has not

200 The New-Orleans Medical and Surgical Journal.

been considered as a subject of natural history." Another half century
has passed away, and nothing has yet been done to acquire a knowledge
of the diseases and physical peculiarities of a people, constituting nearly
a moiety of the population of fifteen States of the American confederacy,
and whose labor, in cultivating a single plant, which no other opera-
tives but themselves can cultivate, without sacrificing ease, comfort,
health and life, affords a cheap material, in sufficient abundance, to
clothe the naked of the whole world. Even the little scientific know-
ledge heretofore acquired concerning them, has been so far forgotten,
that when I enumerated a few of their anatomical and physical peculi-
arities, well known to the medical men of the seventeenth and eigh-
teenth centuries, I was supposed by some of my cotemporaries in the
South to be broaching novelties and advancing speculations wild and
crude. But I would not be understood as underrating the editors of the
Charleston Medical Journal and some other Southern writers, for mis-
taking anatomical facts for wild speculations, and condemning them as
such in their editorial apologies for not publishing the same. The fault
lies not with them, but in that system of education which seems in-
tended to keep physicians, divines, and all other classes of men in Egyp-
tian darkness of every thing pertaining to the philosophy of the negro
constitution. It is only the country and village practitioners of the
Southern States (among professional men), who appear to know any
thing at all about the peculiar nature of negroes— having derived
their knowledge, not from books or schools, but in the field of experi-
ence. It is the latter class of medical men, by far the most numerous
in the South, who have with great unanimity sustained my feeble efforts
to make the negro's peculiar nature known, and the important fact that
he consumes less oxygen than the white man. Until his defective
nsematosis be made an element in calculating the best means for im-
proving the negro's condition, our Northern people ought not to wonder
at finding their colored population, born to freedom, by the side of the
church and school house door, in a lower species of degradation, after
trying for half a century or more to elevate them, than an equal number
of slaves any where to be found in the South. " Will not a lover of
natural history," says Mr. Jefferson, " one who views the gradations in
all the races of animals with the eye of philosophy, excuse an effort to
keep those of the department of man as distinct as nature formed them?"
But no effort has since been made to draw the distinctions between the
black and the white races by the knife of the anatomist, but much false
logic has been introduced into our books and schools, to argue down the
distinctions which Nature has made. It is to Anatomy and Physiology

Dr. Cartwright on the Philosophy of the Negro Constitution. 201

we should look, when vindicating the liberty of human nature, to see
that its dignity and best interest be preserved. "Among the Romans,"
says Mr. Jefferson, " emancipation required but one effort, but with us
a second is necessary, unknown to history." This second belongs pro-
perly to Natural History ; the difference in the last not being artificial,
as among the Romans, or the present Brittons, requiring only an act of
legislation or a revolution to efface for ever, but natural, which no hu-
man laws or governmental changes can ever obliterate. The framers
of our constitution were aware of these facts, and built the constitution
upon the basis of natural distinctions or physical differences in the two
races composing the American population. A very important difference
between the two will be found in the fact of the greater amount of oxy-
gen consumed by the one than the other. If the constitution be worth
defending, surely the great truths of Natural History, on which it rests
as a basis, are worth being made known and regarded by our states-
men. That negroes consume less oxygen than the white race is
proved by their motions being proverbially much slower, and their wrant
of muscular and mental activity.' But to comprehend fully the weight
of this proof of their defective hsematosis, it is necessary to bear in
mind one of the great leading truths disclosed by comparative anatomy.
Cuvier was the first to demonstrate beyond a doubt that muscular ener-
gy and activity are in direct proportion to the development and activity
of the pulmonary organs. In his 29th Lesson, vol. 7, p. 17, D'Anato-
mie Comparee, he says, " Dans les animaux vertebras cette quantity de
respiration fait connaitre presque par un calcul mathematique la na-
ture particuliere de chaque classed In the preceding page he says, — -
"That the relations observed in the different animals, between the
quantity of their respiration and the energy of their motive force, is one
of the finest demonstrations that Comparative Anatomy can furnish to
Physiology, and at the. same time one of the best applications of Com-
parative Anatomy to Natural History." The slower motions of the
owl proves to the natural historian that it consumes less oxygen than the
eagle. By the same physiological principle he can tell that the herring
is the most active among fish, and the flounder the slowest, by merely
seeing the gills of each : those of the herring being very large, prove
that it consumes much oxygen and is very active ; while the flounder,
with its small gills, consumes but little, and is very slow in its motions
as a necessary consequence. Hence the habitual slower motions of
the negro than the white man, is a positive proof that he consumes
less oxygen. The slow gait of the negro is an important element to be
taken into consideration in studying his nature. I have the authority

202

The New-Orleans Medical and Surgical Journal.

of one of the very best observers of mankind, that this element in the
negro's ceconomy is particularly worthy of being studied. It is no less
an authority than the father of his country, the first President of the
United States, the illustrious Washington. Washington knew better,
perhaps, than any other man what the white man could do; his power of
endurance and strength of wind under a given speed of motion. Yet
he found that all his observations on the white race were inapplicable
to negroes. To know what they could do, and to ascertain their power
of endurance and strength of wind, new observations had to be made,
and he mide them accordingly. He made them on his own negroes.
He saw they did not move like the soldiers he had been accustomed to
command. Their motions were much slower, and they performed their
tasks in a more dilatory manner ; the amount of labor they could per-
form in a given time, with ease and comfort to themselves, could not be
told by his knowledge of what white men could do. He therefore
noted the gait or movements natural to negroes, and made observations
himself of how much they could effect in a given time, under the slow
motions or gait natural to them. He did this to enable him to judge
of what would be a reasonable service to expect from them, and to
know when they loitered and when they performed their duty. Those
persons unacquainted with the important truth that negroes are natur-
ally slower in their motions than white people, judging the former by
the latter, often attempt to drive them into the same brisk motions. But
a day's experience ought to be enough to teach them that every attempt
to drive negroes to the performance of tasks equal to what the white
laborer would voluntarily impose upon himself, is an actual loss to the
master ; who, instead of getting more service out of them, actually gets
less, and soon none, if such a course be persisted in ; because they
become disabled in body and indisposed in mind to perform any service
at all. Every master or overseer, although he may know nothing of
the law, above mentioned, discovered by Cuvier, may soon learn from
experience the important fact, that there is no other alternative than to
let their negroes assume, by their own instincts, the natural gait or
movement peculiar to them, and then, like Washington, observe what
can be effected in a given time by that given gait or movement, and to
ask for nor expect more. In Vol. 2, pages 511 to 512, {Washington's
Writings, published by Jared Sparks) are recorded a few of the obser-
vations made by the father of his country on his own slaves, as an illus-
tration of the preceding remarks. It is to be regretted that Mr. Sparks,
out of deference to a modern species of idolatry (all fanaticism is idola-
try), which has taken deep root in Great Britain and despotic Europe,

Dr. Caetwright on the Philosophy of the Negro Constitution. 203

and has from thence been transplanted into our republic, particularly in
the Northern portion of it, should have suppressed so much of the val-
uable observations of Washington on the negro race, as only to publish
a small fragment of the extensive knowledge his comprehensive mind
had stored up on this important subject, well known to his neighbors.
The fragment informs us, that on a certain day he visited his plantations,
and found that certain negro slaves there mentioned, by the names of
George, Tom and Mike, had only hewed a certain number of feet—
whereupon Washington sat down and observed their motions, letting
them proceed their own way," and ascertained how many feet each
hewed in one hour and a quarter. He also made observations on his
sawyers at the same time and in the same manner. From the data
thus acquired he ascertained, in the short space of an hour and a quar-
ter, how many feet would be a day's work for hewing, and how many
for sawing, under their usual slow gait or movement. This hewing and
sawing were of poplar. " What may be the difference, therefore," says
Washington, " between the working of this wood and other, some fu-
ture observations must make known." But Mr. Sparks, out of defer-
ence to the new school of idolatry, having its head quarters in Exeter
Hall, omitted, almost entirely, the publication of any more observations
on the subject, it is no less idolatry to set up an anti-Scriptural dogma
and to make it a rule of action, than to worship a block or a graven
image in the place of the true God. The true God has said in the Pen-
tateuch, the most authentic books of the Bible, "And of the heathen shall
ye buy bondmen and bondmaids [slaves] and your children shall inherit
them after you, and, they shall he your bondmen [slaves] for ever"
Leveticus, Chap. 25, verses 44, 45, 40. But the Dogma or Negro god
of Exeter Hall says that " negro slavery is sin" and that it is contrary
to the moral sense or conscience. Medicine was anciently called the
divine art ; to be entitled to hold that appellation, ought it not to lend
its aid to arrest in this happy republic the progress of idolatry, which is
only another name for fanaticism? And will your learned correspondent
help to arrest it in England ? Or will he, like Prichard, Todd, and
others, make science bow to the policy of his government? — To build
up India at the expense of our Union ? The subject of his investiga-
tions, tubercular disease, if properly studied, leads directly to that spe-
cies of knowledge, enabling him to determine on physiological princi-
ples, which is the best system of ethics, that taught in the Bible, to en-
slave the Canaanite, or that taught in Exeter Hall, to set him free. It
will lead him to the discovery, that the negro, or Canaanitish race, con-
sumes less oxygen than the white, and that as a necessary consequence-

204

The New-Orleans Medical and Surgical Journal

of the deficient aeration of the blood in the lungs, a hebitude of mind
and body is the inevitable physiological effect ; thus making it a mercy
and a blessing to negroes to have persons in authority set over them,
to provide for and take care of them. Under the dogma or new com-
mandment to free the Canaanite, practically exercised in VanDieman's
Land and at the Cape of Good Hope, the poor negro race has become
nearly annihilated. Whereas under that system of ethics taught in the
Bible and made a rule of action in the Southern States, the descendants
of Canaan are more rapidly increasing in numbers, and have more of
the comforts and pleasures of life, and more morality and Christianity
among them than any others of the same race on any other portion of
the globe. They are daily bought and sold, and inherited as property,
as the Scriptures said they should be. Whereas in all those countries
and places in which they are set free, in obedience to the dogma that
" slavery is sin," they rapidly degenerate into barbarism, as they are
doing in the West Indies, or become extinct as in Van Dieman's Land.
The physiological fact that negroes consume less oxygen indicates the
superior wisdom of the precepts taught in the Bible regarding those
people, to any promulgated from Exeter Hall. Experience also proves
the former to be the best. You hear of the poor negroes, or colored
people, as you call them, being beaten with many stripes by their mas^
ters and overseers. But owing to the fact that they consume less oxy-
gen than white people, and the other physical differences founded on
difference of structure, they beat one another, when free from the white
man's authority, with ten stripes where they would get one from him.
They are as much in slavery in Boston as in New Orleans. They
suffer more from corporeal or other punishments in the cellars and
dark lanes and alleys of Boston, New York and Philadelphia, by the
cruel tyranny practised by the strong over the weak and helpless, than
an equal number in Southern slavery. In slavery the stripes fall upon
the evil disposed, vicious, buck negro fellows. But when removed from
the white man's authority, the latter make them fall on helpless women
and children, the weak and the infirm. Good conduct, so far from be*
ing a protection, invites aggression.

But what connection have these observations, you may say, with the
subject of Dr. Hall's inquiries, and what light do they throw on tuber-
cular disease ? They show that there exists an intimate connection
between the amount of oxygen consumed in the lungs and the pheno-
mena of body and mind. They point to a people whose respiratory
apparatus is so defective, that they have not sufficient industry and men-
tal energy to provide for themselves, or resolution sufficiently strong to

Dr. Cartwright on the Philosophy of the Negro Constitution. 200

prevent them, when in freedom, from being subjected to the arbitrary,
capricious will of the drunken and vicious of their own color, who may
happen to have greater physical strength and more cunning; they show
that Phthisis is a disease of the master race, and not of the slave race —
that it is the bane of that master race of men, known by an active haB-
matosis; by the brain receiving a larger quantity of aerated blood than
it is entitled to ; by the strong development of the circulating system ;
by the energy of intellect ; by the strength and activity of the muscular
system ; the vivid imagination ; the irritable, mobile, ardent and inflam-
matory temperament, and the indomitable will and love of freedom.
Whereas the negro constitution, being the opposite of all this, is not
subject to Phthisis, although it partakes of what is called the scrofulous
diathesis. In the negro constitution, as the Frenchman would say,
"Varbre arteriel cede sa prominance a Varbre veineuse" spreading cold-
ness, languor and want of energy over the entire system. The white
fluids, or lymphatic temperament, predominating, they are not so liable
as the fair race, to inflammatory diseases of the lungs, or any other
organ; but from the superabundant vicidities and mucosities of their mu-
cous surfaces, they are more liable to engorgements and pulmonary con-
gestions than any other race of men. In proof of which I beg leave to
refer your correspondent to a standard work entitled " Osbervations sur
les Maladies des JSegres, par M. Dazille. Paris, 1776."

Pneumonia, without subjective symptoms, is very common among
them. Diphtheretic affections, so common among white children, are
very rare among negroes. Intercurrent Pneumonia is more common
among them than any other class of people. It is met with in Typhoid
fevers, Rheumatism and hepatic derangements, to which they are very
liable in the cold season. The local malady requires a different treat-
ment, to correspond with the general disorder. Bad, vicious, ungovern-
able negroes are subject, to what might properly be termed, Scorbutic
Pneumonia — a blood disease, requiring anti- scorbutics. Scorbutic ne-
groes are always vicious or worthless. A course of anti-scorbutics
will reform their morals, and make good negroes out of worthless ones.
They are liable to suffocative orthopncea after measles, and die unless
bled and purged. But purgatives are injurious in almost all their other
affections involving the respiratory organs, except such as act especially
on the liver. They check expectoration, says Dazille, and lay the foun-
dations of those effusions and depots of matter so often mistaken for gen-
uine Phthisis. Auscultation cannot well be made available with them.
The nose pleads to the eye and touch to form the diagnosis, without
calling into requisition the ear. A single examination by auscultation,

206 The New-Orleans Medical and Surgical Journal,

in persons abounding with so much phlegm, is not sufficient to arrive at
a correct diagnosis. Repeated examinations in various postures are
too tedious in execution, and too offensive to the auscultator, to come
into general use in diagnosing the diseases of the melanic race. This
valuable mode of exploration, so useful in many cases, as practised by-
experts, has of late years been carried to a ridiculous extreme, in being
made to deceive and delude more practitioners than it enlightens,
from the haste and inexperience of those who practice it. With ne-
groes it is unnecessary, except in some rare instances. Their diseases,
like their passions, have each its peculiar expression stamped in the
countenance. They are like young children in this respect, They
cannot disguise their countenance like white people. An intelligent
and observant overseer can tell from their countenance when they are
plotting mischief, or have committed some crime ; when they are satis-
fied or dissatisfied ; when in pleasure or in pain ; when troubled or
disturbed in mind ; or when telling a falsehood instead of the truth.
An observant physician has only to bring the old science of prosopos-
copia, so much used by Hippocrates in forming his diagnosis, to bear
upon negroes, to be able, by a little experience, to ascertain the most of
them at a glance by the expression of their countenance.

They are very subject to fevers attended with an obstructed circula-
tion of air and blood in the pulmonary organs. Their abundant muco-
sites often prevent the ingress of air into the air cells, bloating their
lips and cheeks, which are coated with a tenacious saliva. A cessation
of digestion from too full a meal, or some hepatic or other derange-
ment, is soon attended with such a copious exudation of mucosites?
filling the air cells and tracheal passages, as to cause apoplexy, which
with them is only another name for asphyxia. The head has nothing
to do with it. So abundant are the mucosities in negroes, that those in
the best health have a whitish, pasty mucus, of considerable thickness
on the tongue, leading a physician not acquainted with them to suppose
that they were dyspeptic, or otherwise indisposed. The lungs of the
white man are the main outlets for the elimination of carbonic acid
formed in the tissues. Negroes, however, by an instinctive habit of
covering their mouth, nose, head and face with a blanket, or some other
covering, when they sleep, throw upon the liver an additional duty to
perform, in the excretion of carbonic acid. Any cause, obstructing the
action of the liver, quickly produces with them a grave malady, the
retention of carbonic acid in the blood soon poisoning them.

Hence with white people a moderate degree of hepatic obstruction,,
by a residence in swampy districts, is often found beneficial indimin~-

Dr. Cartwright on the Philosophy of the Negro Constitution. 207

ishing the exalted sensibility and irritability of phthisical patients.
Viscous engorgements of the lungs destroy more negroes than all
other diseases combined. They are distinguished from inflammatory
affections by the pyrexial symptoms not being strongly marked, or
marked at all — -by the puffy or bloated appearance of the face and lips
— by the slavering mouth — the highly charged tongue — and by the tor-
por of mind and body. In a word, all the symptoms point to a deficient
aeration of the blood, or a kind of half way asphyxia. A torpid state
of the system, listlessness and inactivity almost approaching to as-
phyxia from the diminished quantity of oxygen consumed by the lungs
of the negro, form a striking contrast with the energetic, active, rest-
less, persevering Anglo-Saxon, with a tendency to phlogosis and phthi-
sis pulmonalis, from the surplus quantity of oxygen consumed by his
lungs. Blistering the nape of the neck, so irritating in nearly all of
the diseases of the Saxon race, is almost a sovereign remedy or speci-
fic for a large proportion of the complaints that negroes are subject to ;
because most of them arise from defective respiratory action. Hence
whipping the lungs to increased action by the application of blisters
over the origin of the respiratory nerves, a remedy so inexpedient and
so often contra-indicated in most of the maladies of the white man, has
a magic charm about it in the treatment of those of the negro. The
magic effect of a blister to that part of the Ethiopian's body, in a large
class of his ailments, although well known to most of the planters and
overseers of the Southern States, is scarcely known at all to the medi-
cal profession beyond those boundaries. Even here, where that portion
of the profession who have had much experience in the treatment of
their diseases, and are aware of the simple fact itself, do not profit by
it in many cases where it is indicated ; because they do not perceive
the indication clearly, so long as the rationale of the remedy remains
unexplained.

Your asking for the proofs of my assertion, " that the negro consumes
less oxygen than the white man," has led me into a new, extensive
and unexplored field of science, where the rationale of that and many
other important facts may be found springing up spontaneously. We
have medical schools in abundance teaching the art of curing the ail-
ments, and even the most insignificant sores, incident to the half-
starved, oppressed pauper population of Europe — a population we have
not got, never had and never can have, so long as we have negro slaves
to work in the cane, cotton and rice fields, where the white man, from
the physiological laws governing his osconomy, cannot labor and live :
but where the negro thrives, luxuriates and enjoys existence more than

208

The New-Orleans Medical and Surgical Journal.

any laboring peasantry to be found on the continent of Europe ; yet
we have no schools or any chair in our numerous institutions of medical
learning to teach the art of curing and preventing the diseases peculiar
to our immense population of negro slaves, or to make them more effi-
cient and valuable, docile and manageable ; comfortable, happy and
contented by still further improving their condition, which can only be
done by studying their nature, and not by the North and South bandy-
ing epithets — not by the quackery which prescribes the same remedy,
the liberty elixir, for all constitutions. The two races, the Anglo-
Saxon and the negro, have antipodal constitutions. The former
abounds with red blood, even penetrating the capillaries and the veins,
flushing the face and illuminating the countenance; the skin white;
lips thin ; nose high ; hair auburn, flaxen, red or black ; beard thick
and heavy ; eyes brilliant ; will strong and unconquerable ; mind and
muscles full of energy and activity. The latter, with molasses blood
sluggishly circulating and scarcely penetrating the capillaries ; skin
ebony, and the mucous membranes and muscles partaking of the darker
hue pervading the blood and the cutis ; lips thick and protuberant ;
nose broad and flat ; scalp covered with a coarse, crispy wool in thick
naps ; beard wanting or consisting of a few scattering woolly naps, in
the " bucks" provincially so called ; mind and body dull and slothful ;
will weak, wanting or subdued. The study of such opposite organiza-
tions, the one prone to Phthisis and the other not, cannot fail to throw
some light on tubercular disease, the subject of your correspondent, Dr.
Hall's present investigation. In contrasting the typical white man,
having an excess of red blood and a liability to inflammatory and tuber-
culous complaints and disorders of the digestive system, with the typi-
cal negro, deficient in aerated blood, and abounding in mucosities, hav-
ing an active liver and a strong digestion, and a proclivity strongly
marked to fall into congestions, or cold humid engorgements ap-
proaching asphyxia, I hope he will be able to find in this unpolished
communication something useful.

I have the honor to be, with great respect,

SAML. A. CARTWRIGHT, M. D.

Dr. Ely on Artificial Respiration.

209

X. — ARTIFICIAL RESPIRATION.

BY ALBERT WELLES ELY, A. M. M. D., NEW ORLEANS.

The bills of mortality, especially in our large cities, exhibit the fact,
that there is no disease prevailing among the juvenile population more
destructive than that called Infantile Convulsions, Epilepsia acuta In-
fantum, Convulsions des Enfans. It prevails with especial fatality
among children under two years of age, a period of infancy when the
infantile nervous system exhibits extreme impressibility, and is liable to
be thrown into convulsions by the slightest disturbing causes. All
children, however, are not equally subject to these convulsions. Those
of large development of the nervous system, large heads, and of preco-
cious intellects, are more especially subject to them.

Infantile Convulsions sweep off large numbers of children annually;
and this is especially true of late years, particularly in the Northern ci-
ties. We think that this class of diseases among children deserves
more attentive study than it has hitherto received, and that much can
be done to diminish its mortality.

We have recently had a case of Infantile Convulsions, of a very for-
midable character, in which we were entirely successful, after three
highly respectable physicians, called in for consultation, had pronoun,
ced it hopeless. We give it publicity, for the purpose of calling the at-
tention of the profession to a feature in the mode of treatment, which
we believe is almost unknown in practice, in such cases — that of artifi-
cial respiration.

The case was that of my youngest infant boy, William F. Ely, aged
four months, who on the 24th of June last became seriously ill, from a
diarrhoea which had been slowly increasing for two or three days pre-
vious. The use of a preparation of kino, on the morning of the 25th
was found to have arrested the diarrhoea, but leaving the child in a co-
matose state, with slight convulsive agitations of the muscles of the
face and other parts of the body. The child lay apparently unconscious,
mouth wide open, breathing sterterously, countenance ghastly pale, the
tongue constantly exhibiting a slight quivering motion, the eyes fixed
and half open, and the slightest sudden noise causing every muscle of
the body to *' jump."

At about one o'clock on the 25th, the child was seized with the most
violent convulsions, purely opisthotonotic in their character, and occurr-
ing every half hour. The phenomena were in the following order :
The child at first exhibited great distress by crying and throwing its
head from right to left ; in a moment afterwards violent twite hings of

210 The New- Orleans Medical and Surgical Journal.

the arms followed, with lividity of countenance and a rolling up of the
eyes. The mouth was constantly wide open, with no frothing or biting
of the tongue, as in epilepsy. The head and feet were violently thrown
backwards, curving the spine into a bow.

At first these fits were of short duration, but became longer and more
violent, each one threatening to be his last and fatal one. The use of
the hot foot bath seemed to arrest the convulsions at first, but they soon
failed altogether to suspend them, and the child, instead of coming out
of the fit, as in the first attacks, and appearing conscious, lost all con-
sciousness, and appeared to be dead. The countenance was ghastly,
the eyes open, set and glassy, the lower jaw fallen, the body entirely
flaccid, the circulation entirely suspended, so far as 1 could discover from
a close examination, the respiration entirely suspended, the extremities
cold — in short, the child was dead, at least to all appearance.

On seeing this termination, I was compelled to pronounce the child
dead. I rose up, paced the room two or three times, thinking upon
what could be further done, when it occurred to me that artificial re-
spiration might restore suspended animation. I flew to the child, lay-
ing in its mother's arms, placed my left hand on its chest, closed the
nostrils with the thumb and finger of my right, and applied my mouth to
^hat of the child. I inflated the lungs gently, and as completely as
possible, four or five times, when a rattling noise in the throat and a
gasp announced the return of animation. Another inflation completed
the work, and the little child once more breathed. I wish it to be par-
ticularly recollected, that during the process of artificial respiration
the child was kept wrapt in blankets, and its feet and legs were kept in
water as hot as it could bear.

After the first restoration of animation, two doses of laudanum of 10
drops each were given, per enema, in the course of one hour, and then
entirely stopped ; but finding that the convulsions would return, after
the second use of artificial respiration, under precisely the same cir-
cumstances as the first above related, two leeches were applied behind
the ear, one on each mastoid process ; and at the same time we began
giving, per enema, one grain of quinine in chicken soup, every two
hours.

Under this treatment the intervals between the convulsions became
longer, until finally they ceased altogether. The leeches were suffered
to take as much blood as they would, and the quinine enemata were
continued.

The last fits, although at greater intervals, were the longest and most
•evere, owing probably to the exhausted state of the child. In the last,

Dr. Ely on Artificial Respiration.

211

which was the seventh or eighth inflation, I almost despaired of seeing
the child breathe again; but by applying additional heat to the surface of
the body, by plunging it entire into a hot bath, and at the same time per-
severing in the inflation, animation was restored. I am satisfied that
the difficulty in the last case was owing to the temperature of the body
having somewhat fallen.

In all this treatment, I am confident that there was but one thing
that saved the child's life— 4he Artificial Respiration. The other means
undoubtedly prolonged the intervals between the convulsions, by allay-
ing the excitement, and strengthening the nervous system ; but at the
close of every fit, after the first three or four, which were very transit-
ory, the child lost its respiration and circulation, and assumed all the
other appearances of complete death. All pronounced him dead ; and
I have no doubt that he would have remained so, if I had not resorted
to artificial respiration. In Infantile Convulsions children perish in the
fit. When, as in the above case, the child at the close of the convul-
sions, loses its circulation and respiration, and assumes all the appear-
ances of death, the child is abandoned as dead, it being supposed that
nothing more can be done. Thousands thus perish, who might be re-
stored by artificial respiration. It must be borne in mind, though, that
in the use of the hot bath we used mustard in the last ; it is absolutely
indispensable to success. If the temperature of the body is suffered to
fall below the natural standard, artificial respiration will be of no
avail.

The pathology of Infantile Convulsions is, as in all the neuroses, ex-
ceedingly obscure ; that is to say, we only know that the nervous sys-
tem is the seat of the disease. It seems most probable that the disease
is purely functional, the parts affected being the spinal cord, involving
the medulla oblongata and the base of the brain. Hypersemia is pro-
bably the pathological condition. This we infer from the action of re-
medies. The disease being purely nervous — mere disorder of function
« — the entire machine, nervous and muscular, was complete ; but the
vital force was so much exhausted by convulsions, that the nerves dis-
tributed to the heart and lungs were too feeble to move them. Although
every thing was complete, there was not force enough in the system
to move the muscles engaged in respiration ; hence the necessity of
moving them artificially, until the machine got fully in motion.

We would call the special attention of the profession to the use of
Artificial Respiration, in Infantile Convulsions, because we conscien-
tiously believe it our duty to do so. We believe it may be the means

212 The New-Orleans Medical and Surgical Journal.

of saving the lives of thousands, who now, under the usual treatment
perish. Let every physician try it. It is an easy remedy, and one
which, in the absence of organic disease, can do no harm.

To sum up from the foregoing — the following treatment we would
recommend in cases of Infantile Convulsions :

1. Immediately after the first fit give Tinct. Opii x guttas every half
hour per enema, until two or three doses are given, and at the same
time commence enemata of Sulph. Quin. 1 grain in chicken soup, every
two hours.

2. Apply, as early as possible, two leeches to the base of the brain
— one behind each ear, on the mastoids. Suffer them to bleed
freely.

3. If at the end of the fit the child ceases to breathe, and the heart
to beat, and the child appears to be dead or dying, immediately resort
to gentle artificial respiration. I say gentle^ because the lungs are
very tender, and violent inflation might rupture them. It must not be
forgotten, too, that the feet and legs, or what would be better, the whole
body, must be immersed in a hot-water bath, as hot as the child could
bear, if well. Without this all inflation would be in vain. At the
very commencement of the fits, the first thing should be to put the child
into a hot bath, and keep the body well wrapped, to preserve the natu-
ral temperature.

4. Continue the Quinine enemata one or two days.

This treatment of Infantile Convulsions, by means of artificial respi-
ration, may be said to afford an argument in favor of Mrs. Willard's
new theory of the motive power of the blood, now advocated by my
learned friend, Dr. Samuel A. Cartwright— a theory which I have re-
cently controverted. Well, what if it does ? My object is truth, sci-
ence and genuine philosophy. I would not conceal a scientific truth,
even if it overturned and completely falsified every old or new theory
that I ever supported, or continue to support, and every line that I ever
wrote. We are simply searching for truth : and if I discover a soli-
tary fact to-day which overturns a theory that I supported yesterday,
would I not forfeit all my right and title to the rank of being an humble
follower of science, by concealing that solitary fact ? He is a fanatic,
a monomaniac, who doggedly adheres to any theory, in the face of
facts.

By all this, however, I do not wish to be understood as admitting
— though I would if I could — that my success in the above case, in the
use of artificial respiration, at all favors the theory that the chief mo-
tive power of the blood is in the lungs. The suspended animation m

Dr. Ely on Artificial Respiration,

213

the above case was owing to asphyxia ; or a stagnation in the pulmo-
nary radicles whereby the left ventricle ceased to be supplied with its
appropriate stimulus, arterial blood. The heart ceased its action from
this cause alone. The difficulty was removed by artificial respiration.
By inflating the lungs oxygen was brought in contact with the pulmon-
ary capillaries, carbonic acid displaced, the blood duly arterialized, and
the stagnation or retardation of the fluid in the pulmonary capillaries
removed. The blood, thus artificially oxygenated, was made to flow
freely to the left ventricle, which, thus receiving its appropriate stimu-
lus, resumed its contractions. The whole system being thus again sup-
plied with arterialized blood, life was restored. All that the artificial
respiration did was to change the venous blood, which clogged up and
retarded the circulation in the pulmonary capillaries, to arterial blood,
which arterial blood stimulated the heart into action, and thus restored
the circulation. It is a well established fact in physiology, that venous
blood clogs up the pulmonary capillaries, so that they cease to allow
circulation. The moment, however, that oxygen is brought in contact
with the venous blood in the pulmonary capillaries, its quality is en-
tirely changed, so that it can flow, and, of course, it flows towards the
left ventricle. Its changed quality alone enables it to flow. The lungs
themselves are entirely passive. The pulmonary capillaries are merely
hydraulic tubes, fitted to circulate a particular fluid — oxygenated blood.
Deoxygenated blood clogs them up, and finally stops the circulation
through them altogether. The idea supported by Mrs. Willard and her
adherents, that the circulation in the lungs is due to a vis a tergo, cre-
ated by an expansion of the blood by heat, loses sight entirely of the
fact, that venous blood does not flow freely through the capillary system
of the lungs. According to this new theory, both venous and arterial
blood ought to flow equally well through the pulmonary capillaries ;
but such is not the case, and hence the new theory is incorrect.

We might enlarge to a great extent on this interesting subject ; but
as we have, in the last number of this Journal, given, in full, arguments
which, as we conceive, completely overthrow the new theory, we deem
it unnecessary to extend this paper. We are not, however, so vain as
to suppose that we are entirely free from error. We reason from such
facts as we know ; and we leave our theories always open to such mo-
difications as new facts may require. Dogmatism, in matters of pure
science, betrays always a weakness, a vanity, which finds an excuse
only in the short vision of man, and in the, as yet, imperfect devel-
opments of humanity.

The New -Orleans Medical and Surgical Journal-

XI. — A FEW REMARKS ON ILEMATOKINETY.

BY SAML. A. CAST WRIGHT, M. D.

What is haematokinety ? It is a newly discovered principle in Medi^
cine. It covers a practical field of vast extent and but partially ex-
plored. The North first announced its existence as a theory. The
South was the first to prove it by direct experiment and actual demon-
stration. The discovery is wholly American. As yet it is very little
known. Haematokinety consists not only in the discovery of those laws
or principles which give life and motion to the blood, but in subjecting
those laws to human control. It represents both the life giving princi-
ple and the blood moving power. It has proved its existence by raising
the dead. Witness the dead alligator it called to life, as reported by
me in the Boston Medical and Surgical Journal of Jan. last, and proved
by the testimony of three respectable eye witnesses of this city. Wit-
ness the child I brought to life, reported in the same paper—and wit-
ness its effects upon an alligator dead and cut to pieces, in restoring ani-
mation and sensation to the pieces, as certified by ten physicians of
New Orleans, and published in Boston on the 7th of the present month
of Joiy. Yet haematokinity is not received without opposition. A
powerful combination of the most learned and talented physicians of
the South have lately attempted to put it down and to scoff it from the
earth. They went out to war against it, certain of a sure and easy
victory. Dr. Albert W. Ely, a most able writer, a scathing critic and
profound logician, brought to bear against it the strong artillery of his
most powerful logic. Dr. Beonet Dowler, the alligator king, known to
the world for his experiments and valuable contributions to science,
brought all his influence and the subjects of his Saurian dominions
against it. Prof. Riddell of the Louisiana University, in the chemical
laboratory, like Saul in the camp of Israel, a head and shoulders above
other men, was to lead up chemistry and micrography against it, after
the logician and the alligator king had made their grand charge. They
chose their own ground and made the issue themselves, contending, that
the alligators, (thought to have been restored to life by haematokinety)
were not dead, but only playing possum, as it is called, and that the
child brought to life was in a swoon, and all would have come to life of
their own accord if let alone. On this ground I met the issue. I pro-
cured an alligator of large size, fierce and vigorous from the battle
ground below this city, and then summoned a jury of divines, professors
and doctors together. The trachea of the animal was tied in their pre-
sence, and soon the animal seemed to die, and was to die if h&ematokin-

Dr. Cart weight's Remarks on Hcemalokinety. 215 #

<aty were true, but only to play possum, if that doctrine had no exist-
ence. I then gave the divines, professors and physicians full liberty to
do what they pleased with the crocodile, and to use any and every
means they could think of, to bring it to life, if they could. The re-
nowned knight, Dr. Dowler, was especially addressed and la grande
Dragonne playing possum, was particularly pointed out to him, and he
was invited to bring it to life, and to take his own time for it. He tore,
burnt, cut, pinched, pulled and pricked the skin, nerves and flesh of the
animal, but to no purpose. He stood by it until he and all the rest of
the physicians, professors and divines were fully convinced that it was
dead sure enough. Now, as he had seen an alligator in exactly the
same situation brought to life by hsematokinety, he surrendered the
ground he had assumed and confessed that on that issue he and all his
followers were hors de combat. Although some copies of his paper,
(setting forth in the title page that tying the trachea would not kill an
alligator) had been printed and was going through the press, he stopped
the press to have that heading struck off. So sure of victory were his
supporters, that they proclaimed a victory in the last number of the
New Orleans Medical and Surgical Journal) before a victory had
been won. In the bulletin of victory haematokinety is represented as
a ruin piteous to behold ! — " a wreck !" — " an idle vision of the brain!""
Soon after this announcement, Dr. Ely and his forces fell into captivity.
Dr. Ely had a son who fell sick and died, a day or two after his grand
demonstration against haematokinety appeared in print. It was a pretty
little boy about six months old. There it lay without breath or pulse.
Dowler and all the doctors, who saw it, pronounced it dead, and left the
house. She of Troy, Mrs. Emma Willard, "FiliaNata Jovis" of the new
world,who first made the discovery of the haematokinetic power,appeared
unto Ely " in a vision of the brain" promising, if he would, like a true
American, declare independence of the old tyrannical dogmas of non
progressive Europe, in regard to vitality and the motive powers of the
blood, and put in practical operation the beautiful, plain and simple
go-ahead philosophy of progressive America, his child should be raised
from the dead and restored to him alive and well ! He choked, trembled,
shook, as if agitated with some violent emotion, and then like Samuel
Adams of the Revolution, raised his arm and abjured all allegiance to
the dogmas, which chain the mind to the footstool of bigotry and folly
in Royal ermine, and immediately set to work to awaken in his dead
son the haematokinetic power, or that power which gives life and mo-
tion to the blood. Wonderful to tell, and no less true than wonderful,
his child came to life ! But he lost faith andkdesisted from the work too

* 216 The New- Orleans Medical and Surgical Journal.

soon. His child died again. Again " the vision of the brain reap-
peared and said, " Persevere /" He persevered, and again the child
came to life. He relaxed his efforts and again it died. He now not
only re-awakened the heematokinetic power and restored life a third
time, but he persevered in the use of all those means calculated to
keep it in activity, until Death was baffled of his prey and left the
house. Dr. Ely's child is now alive and well. Although not an A. M.
a M.D., or a L.L.D., young William Francis Ely has made a stronger
argument in favor of the truth of the American discovery than the
scathing and able argument which appeared against it in the last num-
ber of the New Orleans Medical and Surgical Journal over the signa-
ture of Albert W. Ely, M. D. " When Greek meets Greek then comes
the tug of war" — Ely Junior against Ely Senior. What is singular,
young Ely made his debut, holding in his tiny hands the flaming
sword of Truth to cut America loose from the rotten-borough medical
dogmatism of non progressive Europe, precisely 76 years after our
worthy forefathers cut this country loose from the rotten-borough po-
litical dogmatism of that self-same region.

Prof. Riddell, commander of the reserved forces, has not yet come
in from the battle field, being still in the woods. He had an immense
amount of new and valuable materiel with him — the work of his own
hands, or rather discoveries made by his wonderful microscope. These
have all fallen into the hands of the haBmatokinetists, and are in pro-
cess of being converted into unanswerable proofs of the new doctrine
of life and the motive powers of the blood. They would be worth no-
thing to the able professor if he had them back again, as they cannot
be explained on the old theory now so popular in the schools. If he
could explain them, they would attract no attention from the school
men, who look upon America as a Nazareth, out of which no good
ean come.

What is hsematokinety ? Let Dowler, let Ely, and particularly let
Ely's child tell. What is ha^matokinety? It is a new discovery made
in America, promising, if followed up, to effect great things — even "to
make the old younger ; men more vigorous ; children healthier, and
women prettier." What is hasmatokinety ? It is that new doctrine,
which lays hold of every truth and puts it in motion, bidding it do its
best to carry Medicine forward and make it a progressive science. It
has already unchained truths which medical dogmatism have kept in
prison for centuries.

What is hscmatokinety ? It is what the celebrated Marshal Hall of
London is bending the knee to in his new theory of apoplexy, as pub=

Dr. Cart wright's Remarks on Hamiatokinely, 211

lished in the last number of the London Lancet of this present month
of July. Hall's new theory goes to show that all the old dogmas in
regard to the cause and seat of Apoplexy are fallacious. We outside
barbarians have had Hall's discoveries, (now going through the Lon-
don press,) through the New Orleans press fully two years ago. But
instead of adopting Hall's practice of cutting into the trachea to let in
air to cure Apoplexy, we cut no throats, as the inside non progressives
of London are now doing, but disembarrass the air passages of the
phlegm, which excludes the ingress of air by the use of apophlegma-
tics. A simple, safe and expeditious method of cure. If Dr. Marshal
Hall and his inside non progressives want to know how this is done,
they will have to read an old number of the New Orleans Medical and
Surgical Journal, where a lengthy and full account of the process will
be found, and where Dr. Hall will find his theory with a better practice
affixed to it than the throat-cutting one he has adopted.
144 Canal street, Neiv Orleans, July 29th, 1852.

|p art

EXCEEPTA.

I. — Lectures on some of the more important points in Surgery.

BY J. G. GUTHRIE, F. R. S.

When the wound of an extremity is of so serious a nature as to preclude
all hope of saving it by scientific treatment, that limb should be amputated as
soon as possible.

An amputation of the upper extremity may almost always be done from the
shoulder-joint downwards, without much risk to life, and when necessary, the
sooner it is done the better.

An amputation of any part of the lower extremity below the knee down-
wards, may be done forthwith, with nearly an equal chance of freedom from
any immediate danger, as of the upper extremity, at or near the shoulder-
joint.

It is otherwise with amputations above the middle of the thigh, and up to
the hip joint. They are always attended with considerable danger.

There can be no doubt, that if the knife of the surgeon could in all cases
follow the ball of the enemy, or the wheel of a railway carriage, and make a
clean good stump, instead of leaving a contused and ragged wound, it would
be greatly to the advantage of the sufferer ; but as this cannot be, and an ap-
proach to it even can rarely take place, the question naturally recurs, at what
distance of time after the receipt of the injury or accident can the operation be
performed most advantageously for the patient?

In order to answer the question distinctly, it should be considered with re-
ference to two distinct states of injury :

1st. When injuries require amputation of the arm below the shoulder-joint,
or of the leg below the knee, these operations may be done at any time from
the moment of infliction until the expiration of twelve or twenty-four hours,
without any detriment being sustained by the sufferer with regard to his reco-
very; although every one, under such circumstances, must be desirous to have
the operation over. The surgeon having several equally serious cases of in-
jury of the head or trunk brought to him at the same time as two requiring
amputation, may defer them more safely perhaps than the assistance he is also
called upon to give to the other cases, the postponement of which may be at-
tended with greater danger.

2d. This state embraces those great injuries, in which the shoulder is car-
ried away with some injury to the trunk, or the thigh is torn off at or above its
middle, rendering an amputation of the upper third or at the hip-joint necessary;

Bxcerpta.

219

and it is this, or nearly this state, which alone implies a doubt as to the pro-
priety of immediate amputation, and demands further investigation. It is the
state to which the attention of medical students is earnestly drawn for future
observation.

It has been implied, if not actually maintained, that a man could have his
thigh carried away by a cannon shot without being fully aware of it ; or, if
aware of it, that it did not cause much alarm ; in fact, that it did not materially
signify as to his apprehension, whether the ball took off his limb or the tail of
his coat, or only grazed his breeches. An instauce of this kind has not fallen
under my observation.

A suro-eon on a field of battle can rarely have a patient brought to him, re-
quiring amputation, under less time than from a quarter to half an hour ; a
surgeon in a ship may see his patient in less than five minutes after the receipt
of the injury ; and to the surgeons of the navy we must hereafter defer for their
testimony as to the absence or presence of any constitutional alarm or shock;
and if they occur, to what degree do they follow immediately after the receipt
of such injury. The question must not be encumbered and mystified by a re-
ference to all sorts of amputations after all sorts of injuries, but to the one es-
pecial injury, viz: that of the upper half of the thigh.

My experience, which may be erroneous, like every thing human, has taught
me, that when a thigh is torn, or nearly torn off, by a cannon shot, there is al-
ways more or less loss of blood, suddenly discharged, and which soon ceases
in death, or in a state approaching to syncope. When the great artery is torn,
this fainting saves life, for an artery of the magnitude of the common femoral
does not close its canal by retracting and contracting, as a smaller vessel does ;
it can only diminish it ; and the formation of an external coagulum is neces-
sary to preserve life, which the shock, alarm, and fainting, by taking off the
force of the' circulation, aid informing; and without which the patient would
bleed to death. An amputation in this state of extreme depression, might de-
stroy life.

If the cannon shot, or other instrument capable of crushing the upper par?
of a thigh, should not divide the principal artery, and the sufferer should not
bleed, it is possible he may be in the state alluded to, in which the patient, for
he may not be called sufferer, is said to be just as composed as if he had only
lost a portion of his breeches. Nevertheless, few have seen a man lose even a
piece of his breeches by a cannon shot, without perceiving that he was indis-
putably frightened.

Whilst some persons, under the loss of a limb high up, are reduced to a state
of syncope, or nearly approaching to it, which renders them almost, or even
entirely speechless ; others suffer extreme pain, and earnestly entreat assist-
ance, under which circumstances amputation should be performed forthwith.
In the former, the administration of stimulants may render the operation less
immediately dangerous.

Chloroform, or other similar remedies, raav produce an effect in such cases
yet unknown. Its careful administration may not destroy the ebbing powers
of life, and may render an amputation practicable, which could not otherwise
be performed without the greatest danger. It may be otherwise ; the point,
however, is to be ascertained, although in all cases of great suffering its use
should be unhesitatingly adopted.

When the sufferer is brought to the surgeon at the end of half an hour, hav-
ing lost a limb below the thigh or shoulder, by a cannon shot, he will often be
found in a state of such great depression as to be likely to be destroyed by the
infliction of a serious and painful operation like amputation. This has occurred
to me so often, as to induce me to recommend delay for five, six, or even eight
hours, if the unfortunate person did not suffer much, and appeared likely to be
revived by the use of stimulants.

220 The New-Orleans Medical and Surgical Journal.

This recommendation originated from the fact, that as one seriously wounded
man has as much claim as another to the attention of the surgeon, all could
not be attended to at the same time ; and the success following the deferred
cases of amputation was as great, if not greater, than in those on which the
operation was more immediately performed.

The advantageous results of primary amputations, or those done within the
first twenty- four, or at most forty-eight hours, over secondary amputations, or
those done at the end of several days, or three or four weeks, has been so firmly
and fully established, as to admit no longer of dispute.

When an amputation is deferred to the secondary period, a joint is often
lost. A leg which might have been cut offbelow the knee in the first instance,
is frequently obliged to be removed above the knee, when done in the se-
cond.

In the secondary period after great injuries, the areolar and muscular textures
near the part injured are often unhealthy, the bones are in many instances in-
flamed internally, and their periosteal membranes deposit on the surrounding
parts so much new ossific matter, as frequently to envelop in a few days the
ligatures on the vessels, and render them immovable, necrosis of the extremity
of the bone following as a necessary consequence, protracting the cure for
months.

Sloughing of the stump, accompanied by inflammation of the vein or veins
leading to the cava, frequently take place. This state of stump is often fol-
lowed by purulent deposits in and upon the different viscera, and principally in
the cavities of the chest. Where febrile diseases are endemic, they often pre-
vail ; the constitutional irritation is great ; the stumps do not unite, or open
out, is apparently united and slough, and frequently after a few days implicate
the veins.

In the first edition of my work on Gun-shot Wounds, and on the great opera-
tions of amputation, in 1815, I said, alluding to the secondary operations — " In
the most favorable state of the stump, the diseased parts do not extend very
deep ; yet it is frequently communicated along the vein, which is found to con-
tain pus, even as for as the vena cava."

" When I have met with this appearance, I have always considered the ves-
sels as participating in (not originating) the disease, which had existed some
days, and thereby more quickly destroying the patient."

I further said, that after secondary amputations the febrile irritation, allayed
by the operation, sometimes returns, and more or less rapidly cuts off the pa-
tient by an affection of some particular internal part or viscus, and especially
the lungs.

" If it be the lungs, and they are most usually affected, the breathing becomes
uneasy; there is little pain when the disease is compared with pneumonia or
pleuritis ; the cough is dry and not very troublesome ; the pulse having been
frequent, there is but little alteration ; the attention of the surgeon is not suffi-
ciently drawn by the symptoms to the state of the organ, and in a very short
time all the symptoms are deteriorated ; blisters are employed, perhaps blood-
letting, but generally in vain ; and the patient dies in a few hours, as in the last
stage of inflammation of the lungs, in which effusion or suppuration has taken
place."

" My attention was drawn to it after losing several cases in this way, as a cir-
cumstance of more than common accident, from its having happened in a young
officer to whom I was paying considerable attention (at Salamanca). Since
that I have had one well marked case at Santander, of a sudden and fatal af-
lection of the lungs after amputation of the thigh, which was under the imme-
diate care of Dr. Irwin."

The late Mr. Rose, of the Guards, communicated a case after amputation of
the arm, to Sir James McGregor, who forwarded it to me, and my old friend,

Excerpt a,

221

the late Mr. Boutflower, who served frequently under me during the latter part
of that war, and aided me in all my labors and views, forwarded to me two
cases, from Fuenterabia, at the same time, which terminated fatally after am-
putation of the arm, from the deposition of a considerable quantity of pus in
the cavity of the thorax.

" So insidious," he says, " was the approach of the disease, that except a
difficulty of breathing which supervened a few hours before death, there were
no symptoms indicating the existence of much morbid affection." No further
notice was taken of this disease by any one in any of the hospitals on entering
France in 1813, neither at St. Jean de Luz, nor Bayonne, nor Pau, St. Sever,
Tarbes or Orthez, until after the battle of Toulouse, where the following cases
occurred, which I published in 1815 :

A soldier suffered amputation of the thigh five weeks after the injury at
Toulouse, in consequence of a gun-shot fracture, when in a very reduced
state, the discharge being profuse, the pain great, hectic fever severe. The
third day after this operatien, from which he scarcely rallied, he complained of
difficulty in swallowing, and pain in the situation ef the thyroid gland, which
was found next morning to be inflamed. In spite of the means employed he
died on the fourth day of the attack, or the seventh after the amputation, in a
state of great emaciation. On dissection, the whole substance of the thyroid
gland was destroyed, a deposit of good pus occupying its place, which des-
cended by the sides of the trachea and oesophagus to the sternum, and had all
but found its way into the larynx, between the cricoid and thyroid cartilages on
the right side.

Daniel Lynch, wounded through the knee joint, at the battle of Toulouse, on
the 12th of April, 1814, had his thigh amputated by the late Mr. Boutfloweron
the 8th of May. The night succeeding the operation he passed comfortably.
Next day, the 9th, the febrile symptoms were augmented. On the J Oth he was
worse ; pulse 150. On the llth he was better. On the 16th he was consi-
dered to be in a state of convalescence, and went on improving until the 22d,
when fever again recurred. On the 28th his stomach became very irritable ;
the stump appeared to be very nearly healed, the discharge being small, and
of good quality ; one ligature remained. 30th, pulse 1 10; tongue of a brown-
ish hue. During tne 31st and the 1st of June he got worse and died. The
stump appeared to have united externally, except where the ligatures came out;
but on cutting through the line of adhesion, the muscular parts within were
evidently unhealthy ; the bone was surrounded for some distance by a case of
osseous matter, including the remaining ligature, which could not be removed
by any force not breaking it. The femur was bare, and showed marked signs
of absorption having commenced, and three inches of it must have come away
if the man had lived. The extremity of the vein was in a sloughing con-
dition.

Having dissected the other extremity for particular purposes, foreign to the
examination into the cause of death, a semi-transparent membraneous bag,
containing good pus, was found accidentally on the tibialis posticus muscle.
The blood in the perinaBl vein outside of it was coagulated ; there were little
or no marks of inflammation, and the matter appeared to have been deposited
without any. The inner side of the soleus muscle seemed simply to be dis^
colored.

The first edition having been published before the battle of Waterloo, the
opinions and facts stated therein became matters for public discussion, and the
reports made by my friends from Baussels, Antwerp, Yarmouth, and Colches-
ter, confirmed all the facts, and I may add, all the opinions of the slightest im^
portance. They were published in the second edition in 1820, and were in-
sisted upon in the third, published June 18, 1827.

Near forty years have passed away since I stated my opinion, that inflanv

222 The New-Orleans Medical and Surgical Journal.

mation of the veins is of two kinds — the adhesive or healthy, from which the
sufferers usually recover, as in the cases of women laboring under the disease
called phlegmasia dolens, and the irritative or unhealthy, occurring after opera-
tions; the disease being communicated by continuity to the vein, rather perhaps
than originating in it. I then said I did not believe that pus is carried from
the inside of the vein to the general circulation, the office of the vein ceasing
as a carrier of blood on the inflammation taking place of its internal tissue,
although I admit that the blood in a vitiated state, from the commencing dis-
ease in the stump, or in the system, may have for some time passed along it
into the general circulation. The inflammation thus commencing may extend
upwards and downwards, and across to the opposite side of the body. I never
saw it actually in the heart, the sufferers dying by the time it had reached aa
high as the diaphragm, and in general not so far.

When a person, after undergoing amputation, is about to suffer from unheal-
thy inflammation of the veins, the pulse quickens, and continues above 90, usu-
ally rising from 100 to 130. The stomach becomes irritable ; there are fre-
quent attacks of vomiting, generally of a bilious character, accompanied by
the usual spmptoms of fever. A few days after the commencement of the com-
plaint, there is usually a well marked rigor, followed perhaps by others, but
exacerbations and remissions of fever are marked. The skin gradually as-
sumes a yellowish tinge, the perspiration is great, the bowels irregular, the
pulse becomes weaker and more irritable, the emaciation is considerable, and
the patient gradually sinks ; or the febrile symptoms may subside, with the
exception of the frequency of the pulse, he rallies a little, but whilst he says
he is better, and the appetite even returns, the deterioration in appearance be-
comes more marked, more death-like, and an accession of fever rapidly closes
the scene. The stump is often not more painful than under ordinary circum-
stances, neither is there any remarkable pain or tenderness in the course of the
vessels.

The practical points are, to draw blood to a sufficient extent, but with cau-
tion, on the accession of fever ; to open out the stump as soon as possible,
even by a division of the external adhesions, the inner parts being usually un-
sound ; to envelop it in a large warm poultice ; to apply cold above — even ice
if procurable — in the course of the great vessels, and to soothe the system by
calomel, opium, and saline diaphoretic remedies, followed by stimulants, cor-
dials, quinine and acids.

Private A. Clarke, 79th Regiment, had his thigh broken by a musket-ball a
little above the knee-joint, at Waterloo, and was admitted into the clinical
ward of the York Hospital, in London, in November. 1816. The bone being
in a state of necrosis, Mr. Guthrie amputated the thigh high up, on the 20th of
January. Pulse before and after the operation 104. On the 25th, pulse 120 ;
skin cool ; tongue moist ; appeared weak and irritable. During the 26th and
27th, symptoms of low fever came on. 28th, suffered severely from vomiting,
general fever, greater prostration of strength ; stump not united, but discharged
good pus. 30th, skin assumed a yellow tinge.

On the 1st of February had a rigor, resembling a fit of ague, and Mr. Guth-
rie declared his suspicion of the formation of matter, probably in the liver, and
of the inflammation of the veins of the stump. The symptoms gradually as-
sumed the character of typhus gravior, and on the 8th he died. On dissection
the liver was found enlarged, and weighing six pounds ; the other viscera were
sound. On examining the stump, an abscess, containing four ounces of good
pus, was found in the under part, near the bone. The femoral vein, and those
going to that part of the stump, were inflamed, and contained coagulated
blood, lymph, and purulent matter, the disease extending from the femoral to
the vena cava. The rigors on the 1st of February marked the formation of

Excerpta.

223

matter, the typhoid symptoms its continuance, and the inflammation of the veins.
Union was discouraged from the first dressing.

The following case is so highly instructive on all points, that it is transcri-
bed from the London Medical^and Physical Journal for 1826 :

Jane Strangemore, aged 28, was admitted into the Westminster Hospital,
September 24th, 1823, with an elastic swelling of the whole of the knee-joint,
measuring twenty-seven inches and a half in circumference. The thigh was
amputated by Mr. Guthrie on Saturday, the 27th, the bone being sawn through
just below the trochanter. She suffered a good deal of pain after the opera-
tion. An opiate was administered to her, and repeated, and she passed a good
night.

28th. The pulse, which previous to the operation was 80, had increased to
100; there is, however, little heat of the skin, and she appears easy. Some
aperient medicine and saline draughts to be given every four hoars. Towards
evening she vomited a quantity of bilious matter ; pulse 120. Three grains
of calomel and one of opium, followed by the common aperient mixture, were
ordered, and an enema. The region of the stomach, to which part pain was
referred, was to have applied to it equal parts of ether and laudanum.

October 1st. Better in all symptoms, but looking irritable and ill; com-
plained of no pain anywhere ; no sickness ; appetite good ; the pulse was still
quick.

8th. Two ligatures have come away ; the wound looks well ; the edges
have nearly healed ; eats meat with a good appetite.

9th. Not so well ; pulse 120 ; skin hot ; feels ill ; complains of pain in the
other leg and thigh, which disturbed her rest. Was well purged and the leg
fomented ; the pain was for the most part felt in the calf of the leg and in
the heel.

10th. Pulse 130 ; tongue furred ; vomiting again of bile ; the pain in the
thigh, extending upwards to the groin, and downwards to the heel is intolera-
ble, particularly in the latter part ; the thigh and leg much swelled, and tender
to the touch, although without redness ; the swelling elastic, yet yielding to
the pressure of the ringer, but not in any manner like an (edematous limb.
Mr. Guthrie pronounced the disease this morning to be inflammation of the
veins, extending from the opposite side ; but after a careful examination, and
on pressure, no pain was felt in the course of the iliac vessels of that side, and
the stump looked well, save at one small point, corresponding to the termina-
tion of the femoral vein.
_ 17th. The symptoms continued nearly the same during the week, the
sickness of the stomach and purging of bilious matter abating at certain in-
tervals.

18th. Ts better, and the pain diminished. She looks somewhat better, but
is becoming thinner.

20th. Less pain in the limb, which is swelled, tender to the touch, and all
the superficial veins are very much enlarged. The groin more swelled and
tender; sickness gone, and her appetite returning ; she is allowed good nour-
ishing simple diet. The stump has been poulticed since the 9th to promote
suppuration.

25th. During these five days it was interesting to see the patient eat, and
desire solid food, and in her extremely emaciated state, seem to enjoy it. The
bowels occasionally deranged. Pulse always from 126 to 136. Js slightly
jaundiced in color, but declares she is better, and will get well.

27th. Gradually sank in the evening, and died; the leg having everywhere
diminished in size, except at the groin, where the swelling was more circum-
scribed, resembling the appearance of a chronic abscess npproaching the sur-
face.

224

The New-Orleans Medical and Surgical Journal*

On examination after death, the termination of the vein on the face of tha
stump was open, and in a sloughy state : above that, for the distance of four
inches, and as high as Poupart's ligament, the inside of the vein bore marks
of having been inflamed, but the inflammation seemed to have been of an
adhesive or erysipelatous character, had gone on to suppuration, and the vein
was filled with purulent matter, lymph, and blood, partly coagulated, partly
broken down. These appearances extended up the cava as high as the dia-
phragm, and traces of inflammation could be distinctly observed almost in the
auricle. This disease had passed along the right external iliac and its branches;
it had descended along the left iliac vein, and its branches in the pelvis to
the uterus, and along the limb to the sole of the foot. At the left groin,
the iliac vein becoming femoral, was greatly distended with pus, apparently
of good quality ; and if the patient had lived a day or two longer, it would
have been discharged by a natural effort, as in chronic abscess ; the viscera
were healthy.

During the last days of this woman's life, no blood was returned from the
lower half of the body, unless by the superficial veins ; yet she was com-
paratively easy, although of a yellow hue, emaciated to the utmost, so as to
represent a living skeleton ; and in this state, with a pulse at 130, craving
for, and eating a whole mutton-chop, and more, at a time, with the most
death-like countenance it is possible to conceive.

These two cases mark the course, the symptoms, and the termination
of inflammation of the veins after amputation, in as clear (if not more clear)
and distinct a manner as any which have been since published, and which they
preceded ; nevertheless, most authors of modern date overlook the first, and
some appear to avoid as much as possible the second.

After the battle of Waterloo, the wounded of the same regiment were sent
i ndiscrimately, some to Brussels, some to Antwerp. Those who remained at
Brussels suffered principally from inflammatory fever after amputation ; those
at Antwerp from the endemic fever prevailing at the time, beginning as an in-
termittent, and ending often in typhus.

The following are instances of endemic fever after secondary amputation,
ending in sub-acute inflammation of the lungs and effusion into the chest :

Charles Brown, 92d Regiment, 40 years of age, at that time a healthy man3
was wounded on the 18th June by two musket-balls in the right hand and wrist;
and was admitted into the hospit&l at Antwerp on the 25th June. On the 5th
of July the arm was swollen above the elbow ; discharge profuse and foetid ;
countenance sallow and dejected ; fever.

8th. Arm amputated above the elbow.

9th, 10th, 11th. A little increase of fever.

12th. A paroxysm of intermittent, to which he had been subject occasion-
ally since he had been at Waterloo. On removing the dressing, the edges of
the stump were retorted ; discharge copious and foetid ; respiration hurried ;
thirst; skin hot; pulse 90; skin yellowish.

14th. Intermittent returned ; head affected in consequence of long contin-
uation in the hot bath.

15th. Complains to-day of fulness and pain in the left side; pulse 100;
skin of a deeper tinge of yellow : a sense of suffocation when in the horizon-
tal position. A blister was applied to the whole of the side of the chest.

16th. Became delirious during the night ; vomited frequently ; became in-
sensible at the hour when the paroxysm of intermittent fever was expected to
return, and died in the evening.

On opening the chest, the lungs were found adhering to the pleura costalis
in several places, and were hepatized ; a quantity of serum and lymph was con-
tained in the left pleura, so as to compress the lung, in which there was a
small abscess. The liver was twice the natural size.

J. Lomax, of the Guards, was wounded at Waterloo, suffered amputation of

Excerpia.

225

the right arm on the 23d August, and arrived at the General Hospital, Colches-
ter, on the 27th August, in a state of high fever, and unable to give any dis-
tinct account of himself. He had had the ague, he said, for many days, which
left him for a short time, but returned again when on shipboard; that on the
25th he was attacked by pain in the side, which was very severe on the 26th,
on which day a blister "was applied, which greatly relieved him. The stump
had an unhealthy appearance, the edges of the wound evincing a disposition
to separate.

On the 28th he was free from pain ; fever unabated, with a tendency to de-
lirium. He sunk rapidly on the 30th, and died on the 31 st, notwithstanding
the use of the most powerful stimuli.

A quantity of serurn was found on dissection on the left side of the chest,
the pleura pulmonalis on both sides was covered with a thick layer of coagu-
lable lymph. The pericardium was distended with fluid. The liver was enor-
mously distended, pushing up the diaphragm, and displacing the lung, having
in its substance a large abscess, containing at least a quart of pus. The stump
did not exhibit any peculiar appearance.

O. Sweeney, 90th Regiment, aged 19, was wounded in the hand on the 18th
of June, 1815, and taken to Brussels. On the 5th of July he left for England,
and arrived at Colchester on the 14th. The wound shortly assumed an unheal-
thy appearance ; haemorrhage took place, and the arm was amputated on the
30th. The day after he had severe rigors for fifteen minutes, followed by fe-
ver. The next day he was better, and appeared to be doing well until the 6th
of August, when fever again recurred. Stump quite healthy in appearance.
On the 7th he was attacked by purging and vomiting, which lasted for several
hours, and reduced him much, returning at intervals until the evening of the
8th. Small quantities of wine and opium agreed best, and a biisterVas applied
to the scrobiculus cordis. On the 9th, he complained of pain and tenderness
in the abdomen, which were relieved by fomentations and an enema. The
stump looked well, and discharged healthy pus in small quantity; and the liga-
ture on the brachial artery came away.

On the 20th his strength failed, and the tongue and teeth were covered by a
dark sordes. The adhesions of the stump appeared disposed tg separate. At
night he was restless, with low delirium ; and on the 11th died, with the com-
plete facies Hippocratica.

On raising the sternum, the pleura of the left lung was found adhering to
that of the ribs, and covered by a thick layer of coagulable lymph. The lung-
was highly inflamed, and on cutting into its substance, a number of small tu-
bercles were observed. The pericardium and left cavity of the thorax con-
tained more than the usual quantity of fluid. During the progress of this
case, eleven days from the amputation, no one symptom existed which could
induce a suspicion of inflammation going on in the thorax. The stump
was in a sloughing condition, but the disease did not extend along the brachial
vein.

Thomas Haynes, 23d Light Dragoons, aged 19, was wounded by a spear on
the back of the left forearm, at Waterloo, which appeared to do well until he
left Brussels for England, when it assumed an unfavorable appearance, and on
his arrival at Colchester, on the 14th of July, it was in a sloughing state. The
pain was excessive, and the tenderness around the whole circumference of the
sore was so great, that he could not suffer the slightest possible pressure with
the finger. He was largely bled, and a solution of sulphuric acid, one drachm
to twelve ounces of water, was applied twice a day to the whole surface, and
the whole kept wet with cold water, which treatment was continued until the
21st, during which period he was bled five times, to about twenty ounces each
time. The acid solution was increased from one drachm to an ounce, and care
•was taken that the sloughing portions only were touched with it. His health

226

The New-Orleans Medical and Surgical Journal.

was considerably amended, and on the whole a favorable result was expected.
At two, on the 22d, a sudden haemorrhage took place, to the amount of three
pints ; a second ensuing on the 23d, the arm was amputated. The pulse con-
tinued quick ; in other respects he was well, until the 25th, when some acces-
sion of fever took place, and increased. He was bled to ten ounces and pur-
ged. On the 26th, the line of incision in the stump appeared to be healed, and
with the exception of the pulse at 140, he had no unpleasant symptoms on the
27th, and was free from pain of every kind. On removing the centre strap,
which had been allowed to remain, a large collection of matter of good quality
issued. On the 28th he was much the same. On the 29th, the countenance
had assumed a death-like paleness ; pulse 120, but intermitted every fifth pulsa-
tion ; breathing short and laborious, but with some pain in the chest, and every
symptom of effusion having taken place. He died at 2 P. M., six days after
the amputation.

The only morbid appearance found on dissection was a large quantity of
serous fluid in the pericardium, which was distended by it, and on both sides of
the chest. The heart and lungs, with their membranes were quite sound. On
examining the stump, the sanative process was found to have been entirely con-
fined to the integuments. No appearance of granulation could be perceived
on the muscular surface.

This last case is worthy of especial observation, on account of the manner
in which sulphuric acid was used in a sloughing state, from one drachm to one
ounce of the acid to twelve ounces of water, not as something new, but as an
ordinary application ; and I am doubtful whether there is any case on record
of such use, anterior to it. Is the use of strong acids in sloughing cases also
due to the war in the Peninsula ? Delpech says yes — a testimony I shall con-
firm in its proper place.

I have departed, in some degree, in the foregoing observations, from the
aphorismal form I had prescribed for myself in the commencement of these
Commentaries. I have done so as an act of justice to those officers who ser-
ved at Toulouse, Brussels, Antwerp, and Colchester, in 1814 and 1815, who
are all now no more, and who labored hard in the then early investigation of
these different states of disease, and have not received the reward they merited
of public acknowledgment. I have endeavored, as the Chancellor of the Ex-
chequer says of Lord George Bentinck, to preserve for them the chastity of
their honor.

Mr. Hunter, in 1793, had described the appearances and the fatal consequen-
ces of inflammation of the veins, as a consequence of injuries inflicted on the
surrounding parts, but I apprehend I was the first person to point out the pre-
valence of this complaint after secondary amputation, and its intimate connec-
tion with certain low inflammatory attacks, attended by destructive purulent
depositions, particularly in the chest, and their more chronic deposit in other
parts. Mr. Rose, of the Guards, published some observations in the fourteenth
volume of the Medical and Chirurgical Transactions, in 1828, confirming the
remarks made by me in print thirteen years before, but without referring to
them. Mr. Arnott has an able paper on the subject in the fifteenth volume.
M. Sedillot thinks he has detected globules of pus in different parts of the circu-
lating system, in persons who died of this disease. Dr. Henry Lee, 1850, one
of the last English writers on the subject, professedly doubts the accuracy of
the observation ; and this point remains amongst others for further investiga-
tion. He admits, however, that in cases where, from long continued disease,
there have been repeated introductions of vitiated fluids into the circulation,
the blood loses much of its coaguluting power, which prevents the admission
by the veins of purulent matter, by forming with it in them coagula, constitut-
ing, he thinks, the essential disease, When the coagulating power of the blood

Excerpta.

227

is thus lost, he thinks it possible that pus globules may then be found circulat-
ing in the blood.

Other late writers, and lastly Dr. Hughes Bennett, think these diseases are
dependent on the introduction of a peculiar animal poison. Attention should
be paid by the medical officers of the public service, wherever there is war, to
the state of the blood, and to the inner lining of the diseased veins under the
microscope ; and all those gentlemen, when in London, should study its use
under Mr. Queckett, at the College of Surgeons, to whose lectures they have
the right of admission, and to whose kindness they will all soon feel greatly in-
debted.

I am not aware that the writers referred to have added any thing to the prac-
tical facts I had related so long before, which is much to be regretted. It is
of little use, although it is a step in the right direction, to describe a disease,
or even to show why and wherefore it destroys, unless a means of prevention
or of cure can also be indicated.

In" the irritable and sloughing state of stump alluded to, haemorrhages fre-
quently take place from the small branches, or from the main trunks of the ar-
teries, in consequence of ulceration ; and it is not always easy to discover the
bleeding vessel, or when discovered, to secure it on the face of the stump ; for
as the ulcerative process has not ceased, and the end of the artery which is to
be secured is not sound, no healthy action can take place, the ligature very soon
cuts its way through, and the haemorrhage returns as violently as before, or
some other branch gives way ; and under this succession of ligatures and hae-
morrhages the patient dies.

Some surgeons have in such cases preferred cutting down the principal ar-
tery of the limb, in preference to performing another amputation, even when it
is practicable ; and they have sometimes succeeded in restraining the haemorr-
hage for a sufficient length of time to allow the stump to resume a more heal-
thy action. This operation, although successful in some cases, will generally
fail, and particularly if absolute rest cannot be obtained, when amputation will
become necessary. The same objection of want of success may be made to
amputation ; and on a. due comparison of the whole of the attending circum-
stances, the operation of tying the artery in most cases is to be preferred in the
first instance, and if that prove unsuccessful, then recourse is to be had to am-
putation ; but this practice is by no means to be followed indiscriminately.
The artery ought to be secured with reference to the mode of operating, as in
aneurism, but the doctrines of this disease are not to be applied to it, because it
is still a wounded vessel with an external opening.

To obviate all difficulties, the part from which the bleeding comes should
be well studied, and the shortest distance from the stump carefully noted, at
which compression on the artery commands the bleeding ; and at this spot the
ligature should be applied, provided it is not within the sphere of the inflamma-
tion of the stump. In case the haemorrhage should only be restrained by pres-
sure above the origin of the profunda, and repeated attempts to secure the ves -
sel on the surface of the stump have failed, amputation is preferable, when-
ever the strength of the patient will at all bear it, to tying the artery in the
groin.

When haemorrhage takes place after amputation at the shoulder-joint, it is a
most dangerous occurrence. An incision shonld then be made through the in-
teguments and across the great pectoral muscle, when the artery may be read-
ily exposed, and a'ligature placed upon it without difficulty anywhere below
the clavicle.

If the state of the stump in any of these cases depend upon the bad air of the
hospital, the patient had belter be exposed to the inclemency of the weather
rather than be allowed to remain in it.

In crowded hospitals, haemorrhages from the face of an irritable stump are

2.23 The New- Orleans Medical and SurgicalJournaL

not unfrequent, and often cause a great deal of trouble and distress. It is not
a direct bleeding from a vessel of sufficient size to be discovered and secured,
but an oozing from some part of the exposed granulations, which are soft, pale
and flaccid. On making pressure on them, the haemorrhage ceases, but shortly
after re-appears, and even becomes dangerous. This hosmorrhage is usually
preceded by pain, heat and throbbing, in the surface from which it precedes.
There is irritation of the habit generally, and a tendency to direct debility.
The proper treatment consists in the removal of the patient to the open air,
with an antiphlogistic regimen in the first instance, followed by the use of qui-
nine and acids ; cold to the stump, in the shape of pounded ice or iced water,
with ^occasional styptics to suppress the immediate bleeding. Escharotic and
stimulating applications should be used with caution.

{London Lancet, July, 1852.)

n.—~ On the detection and preservation of Crystalline Deposits of Uric Acid, Ur-
ate of Ammonia, Phosphate of Lime, Triple Phosphate, Oxalate of Lime,
and other Salts,

BY ARTHUR HASSALL, M. D.

Several medical friends have written to me from time to time for instructions
in the method by which the above and some other crystalline deposits may
be permanently preserved for study and for comparison, as microscopic prepa-
rations.

As it is of the utmost importance that every facility should be afforded for the
study of the various derangements to which the renal secretion is liable, as it
is by the united labors of many inquirers that we can hope ever to arrive at a
complete knowledge of the many pathological conditions of that fluid; and as,
further, many men are deterred from following out investigations of this nature
in consequence of supposed difficulties, many of which are rather imaginary
than real, I propose, in the present communication, to put together a few brief
and simple observations and directions, showing the characters by which the
principal deposits may be distinguished, and when discriminated, how they may
be permanently preserved.

The materials required for the preservation of the depoits which occur in the
renal fluid, when in a morbid condition, are test tubes, distilled water, a cam-
el's hairbrush, glass slides, cells, covers for the cells and cements.

The slides, for the sake of uniformity, and for convenience of disposal in the
drawers of the cabinet, are now all made of one size, namely, three inches
long by one broad; in general the slides are quite plain, but sometimes they are
hollowed out in the centre into little pitts or cells.

The cells when separate, should be made out of thin glass, and should be fur-
nished with a large aperture ; they are to be affixed exactly in the centre of the
slide by means of the cement, to be described hereafter.

The covers are to be of still thinner glass, of a circular form, and are to be
accurately fitted by means of cement over the aperture in the cells.

Three different cements are required to secure the cells and covers ; one
should consist of marine glue ; the second of asphalte, dissolved in turpentine ;
and the third of a mixture in equal parts of the second cement and gold size.
The marine glue is to be heated over the flame of a candle, and used to fasten
the cells to the sides ; with the asphalte the margins of the cells are to be
coated over, and on to this, when nearly dry, the glass cover is to be dropped.

Excerpt a.

229.

The object of applying this coating is, that by means of it the cover may be so
secured as to prevent the third cement, which is used to secure the edges of the
cover from running into the cell, and so spoiling the preparation. The slides,
cells ane covers may all be procured from the principal manufacturers of mycros-
copes.

Next to urate of ammonia, deposits of uric acid are the most frequent of all;
they may be recognized by the ey& alone, by their fawn color, more or less
deep, and sandy or crystalline texture. Sometimes, however, the sediment is
so pale, although not absolutely colorless, and the crystals so minute, that a
microscope is necessary to determine their nature ; by the aid of this instru-
ment they may at once be recognized. The primary form of the uric acid
crystal is a rhomb, which is met with in every modification of size and shape,
and in one of two states — either the crystals are single and separate, or else
compound and aggregated, glomeruli or spherules being formed by the crossing
at angles and union of several crystals. It happens occasionally, when the
crystals are very small, that some of them, in place of falling to the bottom of
the vessel, form a delicate scum or pellicle, on the surface of the liquid, which
is very apt to be overlooked altogether, and the nature of which the microscope
only can make known to us.

Deposits of uric acid may be permanently preserved in the following manner
— the supernatant fluid is to be poured off, and the sediment transferred to a
test-tube ; this is to be filled with distilled water, which, as soon as the deposit
has entirely subsided, is also to be carefully poured away, or removed by means
of a pipette ; the tube is then to be filled a second, and even a third time, with
distilled water.

The object of washing the crystals is to get rid of the mucus and soluble
salts, which, as the liquid evaporated, would collect round, and render the crys-
tals indistinct.

But sometimes the crystals of uric acid are concealed in a dense, cloud-like
sediment of urate of ammonia, and this must be got rid of before the uric acid
can be obtained separately. The separation may be thus effected — the super-
natant liquid, except so much of it as contains the urate, is to be poured off ;
the remainder is to be transferred to a large test-tube ; this being gently heated
over a spirit-lamp, the urate is re-dissolved, and the uric acid left free and un-
affected ; the acid is then to be washed in distilled water, in the manner above
described.

The deposit being now well washed, and freed from adherent mucus and the
soluble salts of the renal secretion, is to be removed from the test-tube, and
placed in one of the cells previously affixed to the slide. A soft camel's hair
brush will be found to facilitate the transference and to assist in distributing
the crystals evenly over the interior of the cell.

The cell is next to be set aside until the crystals have been perfectly dry —
lastly, the cover is to be put on and secured as directed, with the appropriate
cements.

Now precisely the same steps must be taken in order to preserve all the other
deposits enumerated ; they must all be collected in the same manner, and well
washed in distilled water.

Urate of ammonia is the commonest of all the deposits ; it occurs generally
as an amorphous powder, very soluble in hot, and but sparingly so in cold wa-
ter ; occasionally, but rarely, it is met with in the form of little shot-like sphe-
rules, and when in this state only is it possible to preserve this salt in a satis-
factory manner. The deposit should be but once washed in very cold distilled
water. Sometimes the spherules collect on the surface, or adhere as a brown
crust to the side of the bottle containing the secretion.

Uric acid and the urates of ammonia and soda are the only colored deposits

230 The New-Orleans Medical and Surgical Journal.

which occur in the renal secretion, with the exception of that very rare deposit,
cystine ; the rest are all colorless, and herein we have a simple character by
which uric acid and its combinations may be distinguished from the other de-
posits.

The neutral phosphate of ammonia, and magnesia, or triple phosphate, as it
is sometimes termed, is also very frequently present as a deposit ; the crystals
have the form of a three-sided prism, and aive often so large that they are visi-
ble to the naked nye. In a white glass bottle, held up in the rays of the sun,
the crystals of this salt, as they descend in the fluid, are to be seen shining-
like myriads of minute diamonds.

Very commonly, some of the crystals, instead of falling as a sediment, float
on the surface of the liquid, forming a pellicle ; sometimes the crystals are free,
but more usually they are imbedded and entangled in a gelatinous looking
layer of phosphate of lime.

The modifications in the form and size of the crystals of triple phosphate are
very great, but the whole of the varieties are reducible to the one primary
form.

The bibastic triple phosphate is- a rare variety of renal deposit, and is met
with in the fluid of the kidney, principally when this has been kept for some
time. It presents itself in the form of beautiful feathery stellse, which are ex-
tremely difficult to preserve in a satisfactory manner, as in drying they are apt
to fall to pieces, and so become disintegrated.

Another rare form is the phosphate of lime deposit. The crystals occur some-
times singly, at others in tufts or stellar. Although they usually fall as a sedi-
ment, yet^hey may often be detected floating on the surface of the liquid, either
free or intermixed with crystals of triple phosphate, or entangled in a pellicle
formed of vibriones.

Oxalate of lime is of rather frequent occurrence as a deposit. It may occur
alone, but more commonly it is mixed up with either triple phosphate, uric acid
or urate of ammonia. Some writers state that the crystals frequently do not
form a sediment, but remain suspended in the liquid, and direct that a portion
of the renal fluid should be gently warmed in a watch-glass, to allow of their
subsidence. This is unnecessary, as, if sufficient time be given, the crystals
always fall and collect at the bottom of the vessel containing the secretion. If,
as is frequently the case, there be much epithelium or mucus, the crystals will
become entangled, and concealed indeed in these to some extent. The dumb-
bell form of oxalate of lime is not so uncommon as is generally supposed. As
in the case of the other compounds and salts, the crystals sometimes collect on
the surface of the liquid. I have met with crystals of oxalate of lime, both
octohedra and dumb-bells, so small that their form eould scarcely be distin-
guished even with an object-glass magnifying 420 diameters.

The last of the deposits met with in the renal fluid is cystine. This is ex-
ceedingly rare ; it forms a copious pale-colored precipitate, resembling, to the
eye, that of urate of ammonia, but immediately distinguishable under the mi-
croscope by its crystalline texture, the crystals forming flat, six-sided lamellae,
which are often compound.

Many of the soluble compounds and salts likewise admit of being preserved,
in a manner more or less satisfactory, as urea, nitrate and oxalate of urea, the
chlorides, sulphates and phosphates. Into the method of preserving these I
propose to enter in a second communication.

I have at the present time in my cabinet several hundred preparations of the
above deposits, put up in the manner just described, and many of which have
thus been preserved for years. Of the more interesting and curious varieties,
I have had figures executed, and am now engaged in the preparation of these
for publication, (lb,).

Excerpta.

231

III. — On the separation from the Blood of an excess of water by the Kidneys.

BY DR. OWEN REES.

Let us first discover the uses of water in the blood, the ends answered by its
presence, the necessity for its frequent removal, and for the supply of fresh
water to the system.

The first and most obvious use of water in the blood is to maintain its flui-
dity, and thus to enable various salts and other matters to be presented to the
organs in such a form as to enable their particles to receive the impress of
chemical, and probably electrical actions, in a minuter state of division than
can be compassed by other means.

As regards the action of water in the blood, in its relation to the kidneys and
the skin, we must especially regard the following points :

1st. The density of the blood is, in health, nearly always the same ; and a
large excretion of water calls for immediate supply of a like quantity to the
blood ; and this happens whether the excess of water has escaped by perspi-
ration or in the urine.

2d. The changes which take place in the blood, more especially those of
oxidation, and the formation of the alkaline phosphates and sulphates by the
union of oxygen with the phosphorus and sulphur contained in the albuminous
matters taken as ingesta, require water in order to wash away the salts formed
as the result of this action.

Now there is a constant necessity for a supply of water to keep up the spe-
cific gravity of the blood, and to wash away the oxidated products as they are
formed, whenever, from disordered action, the kidneys allow the water of the
blood to pass away into the urine in large quantity. The sensation of thirst
occurs in all such forms of disease, and its satisfaction is necessary in order
to preserve the integrity of the blood. It is true that the skin, in excessive diu-
resis, is dry, and that cutaneous transpiration is either lessened or altogether
ceases ; but the water which is retained in the blood by this action, is by no
means sufficient to compensate for the abstraction of water which goes on in
nearly all cases of diabetes, whether saccharine or insipid. The guide for the
necessity of supply is the sensation of thirst, and it should always be grati-
fied; for on whatever conditions the diabetes may depend, (and, unfortunately,
we are as yet greatly in the dark with respect to the pathology of this most in-
teresting disease) it will be in vain to hope to treat it, if we do not keep the
blood up to its normal standard, by supplying water to it at any moment it may
be required. Let us think how the blood must suffer in those cases of diabetes,
far from uncommonly met with, in which the urine amounts to eight and
twelve pints in the twenty-four hours. Let us reflect on what the person who
is the subject of disease must lose in water during the twenty-four hours. We
may allow two and a half pints for urine, and two and a half pints for cutane-
oes transpiration, and we shall see then that the diabetic loses more than three
pints per diem extra, assuming that his skin is absolutely inactive, which is
rarely the case. Now six tumblers of water, or thereabout, taken during the
twenty-four hours, is a very large quantity, but I do not scruple to say, is sel-
dom more than necessary to keep the blood in a proper state in diabetes, where
eight pints of urine pass per diem.

There is a fear often expressed by practitioners, that allowing the patient to
drink, irritates the kidneys, and so keeps up the flow of the water — in fact, that
the more the patient drinks the more urine passes. This is true, if fluids be
taken beyond certain limits, but it does not act materially when fluid is taken
so as to satisfy thirst ; and I have always seen greater improvement take place
where this boon was granted to the patient ; and every thing we know of the

232 The New-Orleans Medical and Surgical Journal.

blood, and the necessity of maintaining it at a certain fixed specific gravity,
points to the propriety of allowing it.

Having alluded to diabetes in this manner, it might be supposed that I regard
that disease as an effusion of water by the secreting surface of the kidney.
Should such a condition obtain, however, it can only be a diseased state in-
duced secondarily upon other evils more nearly connected with disturbance of
the chylopoietic organs, and probably the brain. It is not my intention, how-
ever, to enter upon this subject, but merely to suggest that analogy would seem
to point to the probability of an occasional increased flow of water from the
kidney, as the result of some secondarily induced disease of its secreting sur-
face.

(Med. Gaz.July, 1851.)

IV. — On the Gastric Juice.

BY DR. BENCE JONES.

[The conclusion which Dr. Bence Jones arrives at, as to the action and use
of the gastric juice, is, that its proper action is for the solution of albuminous
substancos. He says :]

That this action is prompted, first, by temperature ; for it is found that at an
ordinary temperature, say from 54 ° to 60 ° , the temperature of this room, no
solution takes place. I have the contents of a stomach, which have been here
for many hours, and probably there is not now a particle more in solution than
when the contents were first removed ; the temperature of the room has been
sufficiently low to check all further action, and it must be raised to 96 ° for a
further solution to take place.

The next great agent is motion. During the time of digestion, a certain
motion is, without doubt, constantly taking place in the stomach; but digestion
may take place without any such contraction, or gentle rubbing, as one may
suppose the stomach to be undergoing ; this is proved by the fact that food will
digest when placed in perforated balls, which allow the mixture of the food
with the gastric juice.

Thirdly, salts are of importance in the process of digestion. Common salt,
without doubt, promotes the secretion of acid by its irritation and by its chem-
ical action on the mucous membrane of the stomach. If very much common
salt, however, is taken, the process of digestion appears to be retarded. So
also with other salts. It is probable that even calomel has this property of
stimulating the mucous membrane of the stomach, and thus, at times, of aiding
the digestive process. Another great agent in promoting the action of the gas-
tric juice, is the removal of substances as soon as they are dissolved. As soon-
as substances are dissolved they are enabled to escape, some of them by being
absorbed into the veins, and some of them by passing out through the pylorus.
That some of these soluble matters are constantly being removed from the sto-
mach by the veins, is proved by tying the pylorus, and finding that in the case,
for instance, of a stomach filled with milk, the watery part of the milk will be
taken up from the parietes of the stomach by the veins, whereby the casein is
left, and is much more slowly dissolved; it is certain that the solution is always
going on, that a part of the contents of the stomach is always being dissolved?
while the process of digestion is proceeding.

Lastly, it has been shown by the experiments of German physiologists, that
atmospheric air is not at all necessary to aid digestion. If the contents of a>

Excerpta.

233

stomach be placed in an air-tight vessel, and exposed to a proper temperature,
digestion will take place.

We come then to the conclusion, that the ferment in the saliva is the sub-
stance which acts chiefly upon the most important non-nitrogenous constitu-
ent of our food, namely, starch; and that the ferment in the gastric juice acts
chiefly upon the albuminous or nitrogenous constituents. Agents that stop
fermentation stop digestion ; for example, strong acids, alkalies, heat, alcohol.
The stomach ferment differs from the saliva ferment, in, losing its action when
heated, or when treated with strong acid or alcohol ; also by its necessary
union with an acid. The acid determines the mode of action and regulates
it. If carbonate of potash or soda is added in excess, a totally different action
of the ferment ensues, decomposition begins. Slightly altered ferment, like
slightly altered yeast, may set up lactic or butyric acid fermentations, and there
is reason to suppose that acetic acid fermentation may also occur. You will
remember that the substances existing in the food I divided thus: Water, which
can be taken up of itself ; mineral matters, which are soluble in water or in
dilute acid ; non-nitrogenous organic substances, some soluble, as sugar, and
others, as starch, insoluble in water, but acted upon immediately by the saliva;
others, as cellulose, insoluble even by the saliva or gastric juice, and which
cannot, therefore, serve for the nutrition of the body; and lastly, nitrogenous
substances. The fluid which acts upon this last class of substances is the gas-
tric juice ; it is the proper agent for rendering them soluble. It converts the
albumen, fibrin, and casein into albumen peptone, fibrin peptone, and casein
peptone, which are soluble in water, and are, therefore, easily taken up into
the body to serve the purposes of life.

{Med. Times, June, 1851.)

V .—Extirpation of a Schirrhous Parotid Gland.

BY M. MONOD.

A swelling, increasing in size, and accompanied by lancinating pains had
manifested itself during a twelvemonth, in the parotid region, in the person of
a clergyman, aged 50, of robust habit, and in good health. A hard, insensible
tumor, having the skin in a very vascular condition, adhering to it, was con-
sidered, in consultation, to be schirrhous in its nature, and to call for extirpa-
tion. The operation proved one of considerable difficulty, owing to the strength
of the deep-seated adhesions, which had to be separated by the fino-ers. M
Monod approves of the rule that has been laid down in these cases, of de-
taching the tumor from its adhesions, anteriorly and posteriorly, and then
attacking its deep-seated portion from below upwards, always directing the
knife towards the tumor. The preliminary ligatare of the carotid is thus* ren-
dered quite needless, and if any considerable artery is opened, the bleeding
may always be arrested by pressure on the carotid, and the operation finished
before the vessel is tied.

In the present case, a good deal of bleeding took place from the surfaces of
the incisions, both during and after the operation, but only one vessel had to be
tied. Owing to the great depth and irregular form of the wound, it was con-
sidered proper not to attempt union by the first intention. By the fortieth dav
it had become quite superficial, so that the patient could return to the countrv
He continued to suffer considerable pain in mastication, however, for about a
month afterwards.

The tumor removed was about the size of an egg, hard and lobulated, and

234

The New-Orleans Medical -and Surgical Journal.

exhibited, on incision, the primary stage of schirrhous— the gland in several
parts being unaltered. M. Monod observes that the question may here be
asked, as in other similar cases, whether the parotid itself has been actually
extirpated? In reply to those who maintain the impossibility of performing
the operation without doing injury to the carotid, which lies imbedded in the
gland, he refers to the observations of MM. Nekton and Denonvilliers, which
prove, that as a general rule, the artery lies merely in contact with the gland,
but not enveloped by it — the gland, in most cases, presenting on its deep sur-
face a furrow in which the artery is lodged, this furrow being converted into
a sheath by loose cellular tissue connecting its edges. It is possible, too, for
the changed form of the gland to efface the furrow, and thus completely to
separate the artery from it. These considerations, then, lead to the belief, that
in the majority of cases the parotid may, with suitable precautions, be extirpa-
ted without any injury being done to the carotid. But in the present case.there
was also ample proof that the tumor removed really was the parotid itself, and
not an enlarged gland which had pushed it backwards. Those who were
present, and saw and felt the vast chasm exposed, leaving only a thin layer of
tissue in front of the spinal column, and exhibiting all the muscular structures,
as if for a demonstration, could entertain no doubt about the matter. A small
portion of the gland around the meatus auditorious, was in fact all that was
left of it. The adhesions, too, were so strong, as to require a very different
amount of force for their detachment, from that necessary for the enucleation
of a diseased gland. A no less strong proof was derived from the effects of the
division of the facial nerve, which passes through the parotid. Prior to the
operation the patient suffered from paralysis of the lower portion of the cheek ;
but immediately after it every part supplied by the facial became paralyzed.
The branches of the nerves were found embedded in the substance of the tumor

{British and Foreign Med. Chir. Rev.)

VI. — On the Treatment of Unconsolidated Fractures by Acupuncture.

BY M. LENOIR.

The case which gave rise to this paper was one of ununited fracture of the
femur, which came under M. Lenoir's care four months after the accident, and
in which, after trying ineffectually to manage it during two months, by main-
taining the ends of the bone in exact and immovable contact, he resolved to
resort°to acupuncture, which Wiessel had already advantageously employed in
1844. Four needles were introduced between the ends of the bones, seven
monthsafter the accident, and retained in situ for six days, by which time they
had excited pain and other symptoms of inflammation. They were re-introdu-
ced during other five days at another point ; exact adaptation of the fragments
and immovability of the limb being sedulously maintained by suitable appara-
tus. The limb was examined on the twenty-third day, but as the fractured part
yielded somewhat under the hand, the splints were re-applied, and the limb re-
examined thirty-five days later. Perfect solidity was now obtained ; and six
months after the operation had been undertaken, the patient was able to leave the
hospital, resuming afterwards the ordinary labors of the peasant.

M. Lenoir observes, that there is nothing more difficult in practice than the
exactly distinguishing between what should be called unconsolidated fracture,
and false joint from deficient callus. Doubtless the one condition is often the
consequence of the other; but it may be asked, where does the first terminate

Exctrpla.

235

and the other commence ? An important question, since the treatment proper
for mere delayed consolidation is not that which is suitable for a completely
organized abnormal articulation. Most writers state, that in facta false joint
only exists when all hope of obtaining union is lost ; as if all fractures were
cured within a certain lapse of time, in all subjects, whatever the physiologi-
cal or morbid condition of these may be. But in subjects even in excellent
health, and of a favorable age, six months may pass without union resulting,
as every surgeon of an extensive practice can bear witness. In such, cer-
tain modifications of the apparatus, additional docility upon the part of the
patient, or care on the part of the practitioner, may suffice to secure a fa-
vorable result.

It is less, in fact, in the lapse of time, than in the disposition of the frag-
ments, that we must seek the difference between delayed union and false joint ;
and the teachings of pathological anatomy are here of high import. Observa-
tions on man, and experiments on animals, exhibit distinct forms of false joints
as consequences of fracture.

1st. In the pseudarthrosis with continuity of Breschet, the separated frag-
ments are united by a band or ribbon of fibrous tissue, the laxity of which ad-
mits of the movements of the ends of the bones; these are more or less rounded,
there is ordinarily no cartilage on their surfaces. Sometimes the ligamen-
tous substance which is attached to, and unites them, partakes of the nature of
cartilage, and in certain portions of its extent the ligamentous and cartilaginous
tissues become blended.

2d. In the pseudarthrosis with contiguity of Breschet, we always find that the
ends of the bones are more or less in proximity ; their opposed surfaces being,
when the fracture is of old date, covered with cartilage ; and an abnormal
synovial membrane, with a ligamentous substance, more or less resembling a
fibrous capsule, surrounding the whole. This kind of false joint has been de-
scribed by many writers, and is easily produced experimentally. Of nine pseu-
darthroses thus produced by Breschet and Villerme, six were of this descrip-
tion.

3d. The fragments may be devoid of all means of union, the extremities of
the bones being mobile, and placed at some distance from each other. Earle
and other writers furnish examples in which the interposition of the muscles
has prevented union.

4th. Norris endeavors to establish the existence of another form, in which the
osseous extremities are united and surrounded by cartilage, movement being-
possible between them. M. Lenoir believes that this is but a stage in the forma-
tion of normal callus, which has been mistaken for false joint.

In respect to the mode of development of the two first named varieties, the
fibreus tissue that at a later period unites the fragments in the pseudarthrosis
ivith continuity results from the plastic substance furnished by the ends of the
bones at the early stages of every formation of callus — solid matter not being
deposited. The ligamentous substance is thus always found broader where
attached to the fragments, than at its middle part. In the pseudarthrosis with
contiguity, either fibro-plastic matter is not furnished by the periosteum and
fragments of bone — its component parts not being found in the blood, as in
several diatheses — or the matter after exudation loses its consistency, and be-
comes unfit to effect consolidation, as occurs in several severe forms of fever ;
or again, this matter, though sufficiently secreted, and possessed of the neces-
sary qualities, becomes disintegrated as soon as formed by the extremities of the
fragments of the bones themselves, as when the limb is subjected to violent or
constant movements.

In all such cases a false joint is formed sooner or later. At an early
period, however, the phenomena which characterize pseudarthrosis and simply
delayed union, are the same. The sole difference recognizable in these two

236 The New-Orleans Medical and Surgical Journal

states is, that the causes which produce the solution of the formative matter
of the callus are in the first case of prolonged or constant operation, while in
the other they are temporary and sudden. Thus the solidification of the frac-
ture may remain suspended, or nearly so, during all the time these causes are
in operation, and only resume its normal course when the blood, modified by
regimen or treatment, can furnish the due solidifying material So, too, un-
der the operation of local causes, disintegrating the effused matter (as ill re-
duction of the fracture, excessive riding of the fragments, the injudicious ap-
plication of bandages, or the incessant movement of the parts) the consolidation
is deferred until these errors are remedied. The practical rule is, in all cases
to act as we had to do with a simple case of delayed consolidation, and to
employ at first only the simplest means, as, for example, acupuncture. This
would prove unavailing in a case of pseudarthrosis with continuity, in which
resection of the bones would alone avail.

Jn all cases in which the seton is indicated, acupuncture may be advantage-
ously substituted ; for while acting in the same manner as the former, the lat-
ter admits of a more graduated application, according to the indications offered
and the effects produced. The absence of these advantages in the seton may,
in some cases, explain its failure. (Ib.)

VII. — -Case of Rupture of the Vagina, with "passage of the Foetus into the ca-
vity of the Abdomen,

BY M. DANYAU.

This occurred in the person of a little* robust, bow-legged woman, twenty-
eight years of age. She had been already pregnant three times, delivery hav-
ing on the two first occasions been accomplished by perforation, owing to the
great contraction of the entrance of the pelvis. On the third occasion labor
was induced at the eighth month, and was followed by peritonitis, iliac abscess,
and puerperal mania. On the 18th June, 1848, arrived at the end of her fourth
pregnancy ; she came to the hospital with commencing labor pains. The liq.
amnii had been discharged nine hours ; and under the iufluence of strong
pains it was hoped, that owing to the small size of the child's head, the narrow
orifice might be passed. The severity of the pains, however, rendered the
woman very restless, and while tossing about she fell off the bed. She re-
sumed her place unaided, and declared she had received no hurt. However,
the pains at once ceased, the head could no longer be felt, the abdomen became
very tender, and the woman's voice, pulse and countenance underwent such
alterations, as to lead to the conclusion that the child had passed into the
cavity of the abdomen.

M. Danyau called on her one hour after, resolved upon attempting turning in
preference to the Caesarian section. On passing in the hand, the uterus was
found thrust upwards, a litjle forwards and to the right — the entire left half of
the vagina being separated from it. Owing to the small size of the child, its
extraction was performed with more facility than had been anticipated — a per-
foration at the base of the cranium with Smellie's Scissors sufficing to lessen
the head sufficiently. The placenta was easily removed from the abdomen, and
no intestine descended through the vaginal aperture. No haemorrhage oc-
curred, but the patient seemed reduced to a state of hopeless exhaustion. She
rallied, however, and in fifteen days, though advised to the contrary, she left
the hospital. An examination per vaginam, made on the ninth and fifteenth

Excerpt a.

231

days, furnished little idea of the severe lesion that had occurred — scarcely even
any irregularity remaining at the place where the rupture had occurred, and
the cervix uteri appearing just as it should do at the end of a fortnight. Soon
after going' out she was seized with iliac inflammation, requiring antiphlogistic
treatment, from which she recovered.

M. Danyau refers to Goldsoirs work (1787), in which the author relates a
similar case to the above, and collects various instances to show that many
cases reported as examples of rupture of the uterus, have really been exam-
ples of rupture of the vagina. This view was enforced in the treatise De
Ruptura, published by Boer at Vienna, in 1812, in which additional confirma-
tory facts are adduced. All these cases have been republished in the Archives
Generates for November, 1827. M. Danyau has not been able to find many
cases on record, narrated with sufficient exactitude to assure their identity
with his own^as examples of rupture of the peri-uterine portion of the vagina,
with passage of the child into the abdomen.

M. Danyau refers to seventeen cases, and in none of which gastrotomy was
resorted to. out of which four only terminated successfully — those of Douglass.
Ross, Smith and the author. In the thirteen others death resulted, either be-
cause the nature of the case was misunderstood, its progress too far advanced
for interference^— such interference being too long delayed — or from consecu-
tive accidents, of which last, however, only one example is on record. The
rarity of such consecutive accident?, and the successful issue of the four cases,
teach the necessity of prompt decision, as well as careful examination. ( lb.)

V1TI. — -On tome points of the Surgical Anatomy of the Mammary Region.

BY M. GERALDES.

In this paper M. Geraldes draws attention to certain dispositions of the
fibrous capsule of the breast, which, although adverted to by Sir A. Cooper,
and other writers on the anatomy of the organs, he believes have not yet re-
ceived their full practical application. And the firstof these is the occurrence,
at the anterior portion of the fibrous capsule, of certain small cavities, filled
with fine fat, communicating with the adipose structure covering the organ,
and either terminating in culs-de-sac. or sinuously traversing the substance of
the gland ; these fatty substances do not always intercommunicate. At the
posterior surface of the breast, the capsule exhibits no asperities or cavities,
but consists of a very dense, resisting, fibrous lamella, which is continued into
the substance of the gland. The circumference of the fibrous capsule is con-
tinuous with the facia superficialis, one lamella of which is fixed to the edo-e
of the capsule, while the other passes behind it; a kind of cavity of consider-
able size, in which fluids may accumulate, being thus formed. By means of the
attachment of this fascia to the clavicle, the mammary gland is, as it were, sus-
pended, and maintained in situ, and hence, whatever size it may reach, it does
not undergo displacement.

Abscesses of the breast may occupy different localities, some being devel-
oped in the adipose tissue covering it, and others within the substance of the
gland, or even behind the organ, between it and the fascia superficialis. The
glandular abscesses are always developed within the little fatty cavities above
described, or in some of the sinuosities which lead from these and traverse the
gland. As these cavities do not always intercommunicate, M. Giraldes re-
commends that the abscesses which form in them should be opened by means
of punctures, in place of free incisions, as these last may implicate parts

236

The New Orleans Medical and Surgical Journal.

that are not the seat of suppuration, and may yet fail to open into the source
of the pus, which may originate at some distance from the point at which
its presence is apparent. When, however, the abscess is situated at the
posterior part of the gland, free incisions at the circumference of the organ
are required.

In the next place, it is to be observed that the fibrous capsule of the breast
completely surrounds all the lactiferous canals, giving to each lobe and lobule
of the organ its special envelop. This fibrous covering is more firm and re-
sisting in the young, and more lax in women who have borne children. The
consideration of the presence, amount, and destiny of this fibrous sheath, espe-
cially where it surrounds the glandular vesicles, is of great importance in
enabling us to properly comprehend the nature of certain tumors of the breast.
The vesicles or acini terminating the lactiferous canals are liable to become
abnormally dilated, and then the fibrous tissue which accompanies them be-
comes more or less hypertrophied. In this way are produced hard, rounded,
movable tumors, of a size varying from a pea to a pigeon's egg, more or less
embedded in the substance of the gland. They are especially found in young
persons, and are often supposed to originate after external irritation, as by pres-
sure. They have been mistaken for scirrhous and fibroid tumors, and on ex-
amination after removal, are found to consist of a whitish or yellowish mass,
ih which the fibrous element predominates. But upon more minute inspec-
tion, this fibrous substance is found to be pierced by cavities of varying ca-
libre, in which is found a mixture of liquid and altered epithelium. In some
cases the fibrous hypertrophy may be absent, and the vesicular tumor may
inflame, burst, and send forth fungus vegetations. (Ib.)

IX. — A Case of Medio- Carp an Luxation backwards.

BY M. MAISONNEUVE.

In this paper M. Maisonneuve relates the particulars of what he believes
to be an undescribed luxation, observed in the wrist of a man who died
soon after a fall from a height of forty feet. At first sight it had the ap-
pearance of a fracture of the radius, the hand being carried backwards,so,
as to represent the figure 7. On dissection the extensor tendons were found
uninjured, though thrust backwards, and the seat of the lesion was disco-
vered to be in the medio-carpan articulation. The radial portion of the sca-
phoid, the entire semilunar, and a portion of the pyramidal bone, remained
attached to the forearm, their anterior and posterior ligaments being unin-
jured. The bones of the second row had undergone no alteration of their
relations to the metacarpus, but they were separated from, and mounted
backwards upon those of the first row. The accident was, however, a luxa-
tion complicated with fracture, as a portion of the scaphoid remained united
to the trapezium, and a portion of the pyramidal, carrying with it the pisiform,
had followed the unciform bone. The flexor muscles were stretched, but
not torn. .The external and internal lateral ligaments of the radio-carpal ar-
ticulation were completely torn, as were the ligamentous bands uniting the
two rows of the carpus. The signs furnished by the accident were precisely
those which Voillemier attributes to the radio-carpan luxation; but the diagno-
sis between these accidents would be of little consequence, as the treatment
would be the same. {lb.)

Exccrpta.

230

X. — Case of Cancer of the Stomach

BY M. WILSON, M. D.

I have selected the following case for description from amongst many, be-
cause the unusual duration of the interval between its arrival at the commence-
ment of the third stage to the death of the patient, is as interesting as it is re-
markable. I will not attempt, in this short paper, either to detail the symp-
toms as they arose, or to enter into a minute relation of the methods of treat-
ment adopted, but merely give a slight sketch of the landmarks, as it were,
exhibited in the progress of the disease.

About the year 1845, Mr. C. B, complained occasionally of indigestion and
derangement of the functions of the liver and stomach, accompanied with head-
ache, languid circulation, and inactivity of the skin and bowels. For these
symptoms mercurial aperients were administered, with varying relief. The
fittacks gradually became frequent and obstinate, the intervals of ease dimin-
ished, and he began to be much distressed by continued constipation. The
skin also assumed a peculiar, greenish-yellow tfnt, characteristic of cachexia,
and frequently associated with cancer.

In the early part of 1850, a small, deep-seated swelling was detected to the
right of the mesial line, in the umbilical region, which was not painful on
pressure. At this time serious attacks of vomiting commenced, and he threw
up large quantities of dark-brown, almost black, viscid matter, as often as once
a week, and which chiefly came on at night. Towards the end of summer of
that year, these attacks of vomiting succeeded every meal, and the matter ejected
was in larger quantities, and in consequence he was soon emaciated and weak-
ened.

In September his symptoms became so urgent, that a speedy dissolution was
expected. Nitrate of silver, Prussic acid and charcoal were administered, with
some relief, for a few weeks ; but in December the vomiting and fetid eructa-
tions had acquired their original violence ; the stomach would not retain the
smallest quantity of solid food for even ten minutes, and he was reduced to the
lowest state of emaciation and debility. As a last resource, and when the pa-
tient appeared to be dying from innutrition, a mutton chop, thoroughly boiled,
and pounded into apultaceous mass, was given to him, which happily remained
in the stomach, and this diet was continued daily.

An unexpected improvement in the disease commenced. On the 3 1st of
March, 1851, he had increased in weight twenty-eight pounds; the vomiting
was much diminished in frequency, and the pain in the abdomen was consid-
erably relieved ; the tumor, however, retained its size and position. He seemed
to have regained his strength, enjoyed exercise, and pursued his avocations
with pleasure.

On the next day, the 1st of April, he was suddenly seized with faintness,
and ejected from his stomach, with slight effort, a pint and a half of bright red
blood. Two days afterwards this was repeated in smaller quantity, and he
passed much black and decomposed blood.

He was again extremely reduced, but in about six weeks so far recovered
as to follow his ordinary business. From the debility caused by this attack,
however, he never entirely recovered.

The cancerous symptoms began gradually to progress ; the tumor increased
in size; the vomitings were not so frequent, on account of the increased capa-
city of the stomach, but the quantity vomited at each attack was greater ; the
eructations were more constant and distressing; increased debility and ema-
ciation followed as a natural consequence, and in January, 185:2, he died, ex-
cessively wasted in flesh.

A post-mortem examination confirmed the accuracy of the diagnosis. The

240

The New-Orleans Medical and Surgical Journal,

pylorus was closed by a cancerous mass ; a ring- of colloid matter, whiefi
passed in front of the opening, entirely preventing the passage of nourish-
ment into the intestines. Just above this, the structure of the stomach had
been destroyed by cancerous ulceration, but the escape of matters from the
opening into the cavity of the abdomen had been prevented by adhesions to
the under surface of the liver; these adhesions had evidently taken place
for some time previously. It was from this ulceration, no doubt, that the for-
midable haemorrhage of April, 1851, proceeded.

It thus appears, that from its commencement, the disease had existed for
nearly six years, the last stage being prolonged to the unusual term of two*
years.

(London Lancet for June, 1852.)

XI. — Case of Variola cote mporaneo us with Vaccina, both modified.

BY ROBEBT FOWLER, M. D.

On March 31st last I vaccinated Marianne W., aged three years, a per-
fectly healthy child. When next seen, April 7th, I was told that on the very
day (April 1st) following vaccination, she became very sick, vomiting fre-
quently and feverish. On the evening of the next day, April (2d) the mother
fancies that there was a little redness about the chin, which, however, on the
3d April assumed the aspect of decided papulae over the whole face, arms, legs
and body. I now ascertained that at the school to which the child had gone
up to the day of its being taken ill, two or three of the scholars had had the
small-pox about a month ago, and had returned among the other children some
few days back.

April 8th. The vaccine vesicles (seventh day) are larger than the vario-
lous, very little elevated above the cuticle, irregular in shape, being not per-
fectly circular, but flattened and indented, and iobulated at the edges. There
is evidently very little fluid in them, and no appearance of areola. The en-
tire body is marked with distinct variolous vesicles, (fifth day) having the same
flattened aspect as, but smaller than, the vaccina ; and being so little elevated
above the surface, they do not present that " shotty" feel so characteristic of
variola, especially in its papular stage. Febrile action slight.

9th. The variolous eruption (seventh day) is more turgid; that on the face
is pustular, and a few of the pustules are beginning to scab ; that on the arm
is hemispheroidal, prominent and pustular ; that on the legs is opaque, but not
distinctly pustular; the central depression still existing in some of the vesi-
cles. The vaccinia (ninth day) is not more elevated, though the fluid seems
more opaque; the vesicles are now about half an inch in diameter, but still
present that irregular, indented appearance around their margin, external to
which there is now an areola of about one line in diameter, as there is also
around each variolous pustule. The variolous vesicles in the immediate
neighborhood of the vaccinia are much smaller and less opaque than elsewhere,
neither are they so turgid or spherical as in other parts of the body. The
mother attributes this to the child always lying on that side (which however,
by some oversight was not vaccinated) presents well filled vesicles ; the
eruption of the right leg also is somewhat less prominent than that on the
left, though certainly there is not that marked difference observable in the
vesicles of the two arms.

10th. Variolous eruption (eighth day) entirely pustular, scabbing going ors

Excerptdi

241

in the face. Areola of vaccine vesicles (tenth day) no longer, though the
vesicles themselves are larger, and beginning to lose their indented margin.
The variolous eruptions around vaccinnia is now pustular.

12th. Scabbing progressing on the face, (tenth day) and the pustules on the
arms shrivelling up ; no secondary fever. A scab perceptible (twelfth day)
on each vaccine vesicle ; no increase of areola, nor is there any surrounding
induration.

14th. Some of the pustules on the legs shrivelling (twelfth day.) Vac-
cinia (fourteenth day) scabbing, the scabs being rather conical, and of a dirty
light brown in color ; no increase of areola.

16th. All the pustules of the legs shrivelling (fourteenth day). Scabs of
vaccine vesicles (sixteenth day) have fallen off, leaving an irregularly circular
purple-red mark, larger, though otherwise similar, to the stains of the vario-
lous eruption ; the vaccine stains are perfectly flat and smooth, without the
slightest indication of the small depressions and radiating lines characteristic
of a good vaccine cicatrix.

19th. The whole body presents purple-red stains.

Remarks. — Considering vaccinia as a disease sui generis, we have here two
exanthemata co-existing in one person, and each 'by its presence modifying,
but not superseding, the regular course of the other. That the vaccinia was
modified, is shown by the irregular shape and flattened condition of the vesi-
cles, by the absence of the areola and surrounding hardness, by the shape and
color of the scab, by the duration of the eruption — the scab having fallen off'
on the sixteenth instead of about the twentieth day — and by the character of
the remaining cicatrix. The size of the pustules, and the absence of the se-
condary fever, notwithstanding the duration of the eruption was not considera-
bly shortened, indicate that the variola was of a modified kind. By those
sceptical of the prophylaxis of vaccination, the above case will be greedily
seized on; but are we not from past experience warranted in surmising, ancl
even affirming, that although the discovery of Jenner was in this case incapa-
ble of arresting or superseding the progress of the poison already concocting
in the blood, yet that to the co-existence of the vaccine virus this child owes
the safety and mildness of its attack ? (Ib.)

XII. — On Instantaneous Insanity, considered in a Medico- Legal point of view,

BY DR. P. BOILEATJ DE CASTELNEAU.

[The following is an abridged translation of a paper which appeared in the Anna-
tes d'Hygiene et de Medecine Legale, for January and April, 1851, and we also
observe that it has been transferred and published in full in the Annales Medico-
Psychologiques. It treats of a subject which, unfortunately, requires to be care-
fully investigated in our country, as well as abroad, and although it can scarcely
be regarded as presenting novel views, yet it gives a fair and full account of the
prevalent opinions, at least on the continent of Europe. While it may be a very
serious question whether these opinions should be incorporated into our codes, there
can still be no doubt but that physicians having charge of the insane, should be
prepared to give their views with a perfect knowledge of the facts and doctrines
that have been promulgated. — Ed. Am. Jour. Insan.]

Instantaneous, transitory, temporary insanity is a disease which manifests itself
suddenly. The subject of it is excited to . acts which nothing in his previous history
xvould lead us to suspect.

1- In certain instances the violent act is not preceded by any reasoning.

242

The New-Orleans Medical and Surgical Journal.

2. In other cases there is some reasoning, but it sins against one or more ov
the rules of logic, although others of these may be strictly followed.

3. Occasionally we can discover no predisposition to insanity, and again this is
well marked.

4. It is not altogether uncommon that the unfortunate subject has been aware
of the danger that menaces him ; that he has struggled against it ; that he has
appealed for assistance, and has sought to remove from the place or situation which
has threatened to become the theatre of a deplorable occurrence. But there are
cases also in which the force of impulse has triumphed over conscience.

The first act of insanity may be a murder, and to this the disease may succeed in
its intermittent or continued type. But when a criminal action or a murder is the
sole indication of insanity, it constitutes the instantaneous, temporary or transitory
insanity of authors, [Henke, Marc, Cazauvieilh, etc.] and it is this which we are
now about to consider.

We may here observe, that aside of this species, we find another which renders
the diagnosis difficult. It does happen that after the commission of a murder, fear
or despair may be the cause of supervening insanity in the criminal. The physi-
cian must carefully study the antecedents of the accused, and those of his family,
with the circumstances of the act, in order to establish the difference between san-
ity and insanity.

A celebrated jurisconsult, who will not be taxed with too much leniency, recog-
nizes the reality of instantaneous insanity. "There are madmen," says Bellard,
"whom nature has condemned to an eternal loss of reason, while there are others
who lose it instantly, owing to severe pain, sudden surprise, or some parallel cause.
The only difference between them is in its duration, and he whose head has been
turned for a few hours or a few days, is as completely insane during this ephemeral
delirium, as another in whom it has continued for years. When the maniac has
caused some grievous misfortune, he should be shut up ; this is justice and precau-
tion ; to send him to the scaffold is cruelty."

Amongst the authors who have discussed this delicate subject is Marc, and in his
work he inquires whether we have not met in society with persons, rational and of
an established moral character, who, notwithstanding, avow, that in the course of
their lives they have, at least once, been surprised and betrayed into a sudden excess
of extravagance, and indeed of atrocity. Indeed he quotes himself as an example,
having on one occasion been seized with an urgent desire to push into the water a
young person, seated on the parapet of a bridge. The horror of the idea caused
him to run away from the spot. Talma, the celebrated tragedian, confessed to a
similar thought- Professor Lichtenberg states in his work "Observations sur lui-
meme," that he has often experienced pleasure in reflecting on the means by which
he might destroy the life of this or that person, although he had never conceived a
plan for executing the crime.

The man of letters, D., viewing a beautiful painting by Gerhard, was seized with
so irresistible an impulse to destroy the canvas with a kick, that he was obliged to
turn his back on it.

Dr. Michu relates the history of a female in the country, who, having given birth
to her first child, now ten days old, was suddenly agitated with the desire to murder
it. The idea made her shudder ; she fled from her house, but again returning expe-
rienced the same impression. She left a second time for a visit to the priest, to
whom she confided the cause of her agitation.

Now, in these cases the will remained healthy, and triumphed over the sudden
impulse. But when the opposite happens, there is no moral responsibility. This
last indeed requires a free perception, a proper association of ideas, and an ability to
examine and compare them, and a well-balanced condition of the mental faculties.
Such is the aim of education, and if well directed, it produces moral and intellectual
order.

In examining authorities on this subject, we shall find many who concur in the
belief of the existence of instantaneous insanity.

The editor of the Journal of Practical Medicine and Surgery cites five cases of this
nature. In four, their previous conduct had been altogether irreproachable. In the
fifth, Hie subject, a female, had killed four persons, and among them her mother,

Excerpla.

248

wounded a fifth, broken the furniture, and caused the wine to flow from a barrel.
On being arrested, in reply to the question, " has any one desired you to kill yo'ir mo-
ther?" she said, "No, a bad rush of blood [coup de sang] has caused me to do it.
My poor mother, that I loved so much !" And here tears followed. " But if you
loved your mother, why did you kill her ?" " What do you wish me to say ?'-' Ex-
tenuating circumstances were on the trial admitted, and she was condemned to ten
years imprisonment with hard labor.

Hufeland's Journal reports four cases of a similar nature, related by Dr. Loeven-
thai. One is as follows :

A shoemaker aged 33 years, of the sanguine temperament, a quiet disposition, in-
dustrious, temperate, and in good health, lived happily in his family during four
years. On the 12th of April he got out of bed in good season, to go as usual to his
daily labor. An hour afterwards his wife noticed his incoherent discourse and wild
appearance. Suddenly he threw away what he held in his hand, seized his cutting
knife, and rushed on his wife to kill her and her infant. She had great difficulty in
escaping. Several persons, however, rushed in, and the physicians on arriving,
bled him and prescribed medicines. By mid-day he became calm and slept. At
night he had full use of all his mental faculties, but recollected nothing of what had
happened during the day. The other cases are analogous.

The celebrated Hiern, of Berlin, publishes this case. A public functionary, gen-
erally esteemed, and still living, [1817] the Counsellor of State L , at Berlin, has
enjoyed good health always. One night he awoke suddenly, his breathing was ster-
torous ; his wife wished to assist him, but he attacked her with violent fury, and
made repeated attempts to throw her out of the window. After a contest of an hour
and a half he desisted, from weariness, and the cries of the victim brought aid. An
emetic put an end to this fit of insanity, and during 14 succeeding years there had
been no return of it.

Again a female, subject at every menstrual period to mental disorder, grossly in-
sulted at one of these, another female, and had no subsequent recollection of it.
Professor Barends, of Frankfort, on the Oder, was consulted on the case, and gave
it as his opinion that such a condition was quite possible.

Dr. Boileau De Castelnau proceeds to give additional cases from his and others
experience, and observes that in some of them a dominant circumstance, as a cere-
bral affection in infancy, leaves such a diseased condition of the encephalon, that the
organ is unable to resist an access of violence, and then a slight exciting cause su-
pervening, the individual becomes incapable of preventing the criminal act at the
time, and subsequently losing all recollection of it. Sometimes these insane have
the good fortune immediately to have persons near them who understand their pe-
culiar state. In the following instance, kleptomania [stealing mania] was on that
account not followed by judicial proceedings.

The case is given by Dr. Thore, of a boy aged seventeen years, who was seized
with hallucinations of sight and hearing during convalescence from a very severe
attack of typhoid fever.

He left home secretly, went to a neighboring fruit seller, offered to buy the whole
contents of his shop, and stole a case of prunes. On another day he leaped over a
wall, in order to get the grapes in the garden. Eating these, he was attacked with
fever and diarrhoea, but still continued to steal every thing on which he could lay his
hands, saying it was for his brother. The insanity increased ; he was placed in the
Bicetre, where he died of epidemic cholera in 1849.

Our actual state of knowledge on this subject warrants us, as Doctors Bouchet
and Morel have particularly insisted in their writings, in recognizing diseases pro-
duced by a sensibility which the judgment cannot direct, and manifested by disor-
derly and criminal acts. This form of insanity, indeed, brings along with it more
breaches of social order, than that which arises from perversion of the intellect.

A distinguished psychologist, Dr. Lunier, in agreement with many authorities,
asserts, that through various causes, individuals thus situated are unable to with-
stand the power of some predominant idea, either previously existing or suddenly ex-
cited. Hence this idea may induce suicide, murder or robbery.

To the numerous instances already on record, may be added two which have
occurred particularly under the observation of the author.

244

The New- Orleans Medical and Surgical Journal.

A female concealed her pregnancy. Her parents urged her in vain to confess itj
but she obstinately refused to do so, although a widwife, on examination, had no
doubt of the fact. She was delivered alone. With a small pocket knife she inflicted
very many wounds on the body of the infant, and completed the wkole by cutting
off its head. The bloody remains were concealed Under the bed clothes, but her
parents discovered her situation and the murder. She did not deny it. A neighbor
said to her, " You have committed a great crime, and justice will avenge itself." "I
deserve it," was her answer.

To the public prosecutor she owned her crime, and attributed it to the abandon-
ment of her lover, adding, " do with me as you please."

Now by distinguished medical jurists in this speciality, the great number of wounds
inflicted is deemed a characteristic symptom of insanity. It demonstrates a com-
plete want of moral sensibility, and of the proper appreciation of actions. So also
with the circumstance of the bold avowal of the crime.

But in this case also was urged the excuse of a hereditary insanity. Affidavits
were presented, showing that the mother of the criminal had been attacked With
paralysis during her pregnancy with her first child ; that she lost the use of her right
side, and that this inability continued during the remainder of her life, or for the 12
ensuing years. Further, that during the existence of this palsy she had three chil-
dren ; the first died three days after birth ; the second, the present criminal, had
been irregular at the beginning of puberty, and required medical treatment; while the
third, a boy, was during the first five years unable to talk or walk. Besides this, it
was shown that the maternal grandfather had died in a state of complete mental
imbecility. In conclusion, this official paper stated that the female was of a respec-
table family, and had undoubtedly been seduced under a promise of marriage.

Our author insists much on the condition of the criminal, being in a puerperal state;
greatly influenced by shame and despair, and quotes from Doctors Reid and Webster,
the comparatively great number of cases of this description among the patients in an
asylum.

The Jury found her guilty, with extenuating circumstances (circonstances attenu-
antes), and she was condemned to imprisonment for ten years at hard labor.

Another case was brought before the same court, and directly under the observa-
tion of the author.

An inhabitant of the commune of Gard, returning from labor, met his wife and
accosted her, " my merry one, (gaillarde) is the soup ready ?" She replied with the
blow of a knife, which killed him, and immediately on this endeavored to hide the
body. There was or had been no antecedent circumstance occurring in the family
as a motive for this crime.

She was arrested, and on her way managed to escape from the officers of justice,
and threw herself into a water sluice, from which, however, she was taken out
alive.

On trial, it was proved that she belonged to an insane family. Her maternal aunt
had for many years labored under mental alienation. The daughter of this aunt was
morose and subject to extreme attacks of fury. Again, the father of the criminal
was proved to have frequent fits of rage, so as to induce his neighbors to deem him
out of his head ; the mother was no better ; the maternal grandmother had drowned
herself without any known cause ; and finally, the criminal herself, since her last
pregnancy, had been frequently seized with violent attacks of rage, without any ap-
parent reason. She was confessedly feeble-minded. In one word, the inhabi-
tants of the whole Commune had for a long time united in deeming this an insane
family.

Dr. Castelnau observes, that this case is settled as to its character, by the law laid
down by Georget. That author, after a long research into the nature and history of
homicidal mania, announced the following as a diagnostic between crime and the
blind and irresistible impulses of the will : " A horrible act, a murder, an arson, com-
mitted without cause, without motives of interest, by an individual whose actions
have previously been correct, must be the result of insanity."

In the present instance, this female had no motive, interest, or even pretext to mur-
der her husband. She belonged to an insane family, and every thing proved that
she had acted under an impulse of instantaneous mania. She was pronounced guilty.

Excerpia.

245

but extenuating circumstances were admitted, and the punishment was reduced to
imprisonment with hard labor for ten years.

It is manifest from these repeated verdicts of juries, that whilst they countenance
the idea of insanity, they are still unwilling to return such unfortunate persons upon
the community. This brings us to one of the great wants of the present day, viz :
special asylums for insane persons, authors of qualified offences or crimes, and to
which our courts of justice may send all of them at once.

In Belgium, a law passed June 18, 1850, sanctions this plan. In England, a part
of Bethlem is set apart for the criminal insane. The Commissioners of Lunacy in
that kingdom solicited, in their report to Parliament, in 1844, either an increase in
this respect, or the erection of a bidding solely for this purpose.

But after all, it is of most importance, as has been already pointed out by many
writers on insanity, and by myself in a treatise on the Penitentiary system, published
in 1845, that education should be primarily attended to. In this resides the prophy-
laxis of social order.

If these females had received elementary education, in the true sense of the term,
neither of them would have committed murder. Their moral and intellectual facul-
ties would have been so much exercised, as to enable them to overcome the fatal im-
pulse.

Let us not, however, be understood to assert, that a uniform system of education
can be obtained so as to avoid all evih The mental faculties are extremely diversi-
fied, and there should thus be instruction appropriate to individualities. And even
when this has been attained, we must still be charitable, and judge every one accord-
ing to his particular strength of mind. In one of the cases before us, the female with
the heditary tendency was cruelly seduced, and the criminal thus acting ought, in
justice, to have shared her punishment.

Entertaining, then, a strong conviction, that want of education is a fertile cause of
crime, we have, in common with several friends, and aided by an intelligent admin-
istration, obtained the appointment of instructors in the central prison at Nismes, and
the example has been followed in several others.

Prisons such as they are destroy, and do not correct, and we are forbidden to take
the life of a fellow creature. (The author quotes several texts of scripture in defence
of this.) There should be a Christian Penitentiary System.

Conclusions. — 1. Instantaneous alterations of the mental faculties occur, inducing
instantaneous insanity.

2. Thelirst manifestation of this sudden change may be what we style a crime.

3. The person committing such an act should be placed in an asylum especially
set apart for such.

4. They should remain there until examined by a special jury, and who shall cer-
tify to their cure.

The minimum period of sequestration should be fixed by the court.

Further as to these culpables ; no more death punishment, but a conversion of the
prisons into places of moral, intellectual and professional instruction.

Let us indulge the same commiseration towards aberrations of the mental facul-
ties as we do with other diseased changes. Let us bestow equal attention on both.

This doctrine has nothing dangerous in it ; the danger consists in not acknowledg-
ing the facts which constantly occur, and thus not providing against or preventing the
evils which more or less menace all.

IP art $!)kd.

REVIEWS AND NOTICES OF NEW WORKS,

I.— 'Outlines of a Course of Lectures on the Materia Medica, designed
for the use of Students, delivered in the Medical College of the State
of South Carolina. By Henry R. Frost, M. D.

Pathological Anatomy, an Address delivered at the Royal Cork Institu-
tion. By Thomas S. Holland, M. D., M. R. C. S. LM etc.

Annual Catalogue and Announcement of the Medical Department of the
St. Louis University. Session 1852 — 53.

Annual Announcement and Circular of the Memphis Medical College.
Session 1851—52.

Amputation of the entire Lower Jaw, with disarticulation of both Con-
dyles. By J. M. Carnochan, M. D., Professor of Surgery in the
New York Medical College,

Proceedings of the Medical Association of the State of Alabama, held in

the city of Montgomery, December 8, 1852.
Essay on Empyrical Remedies, read before the Medical Society of the

State of Georgia. By Robert Campbell, M. D.

Report of the Eastern Lunatic Asylum, in the city of Williamsburg, Va.,
1851.

We shall first notice the work of Dr. Frost. This important and
greatly diversified branch of medical education, (Materia Medica) is
frequently passed over by the student of medicine as of minor impor-
tance ; a proper consideration of its claims will at once banish so erro-
neous an opinion. Intimately connected with Therapeutics, Medical
Botany, Chemistry and Pharmacy, the wide expanse of nature, in lav-
ish profusion, invites the inquiring mind to cull from indigenous and
exotic plants all such as may be rendered available to man's medica-

Reviews. — Addresses, Reports, etc.

247

tiori ; and diving beneath the surface, the metallic and mineral king-
doms yield a rich supply for the laboratory ; and here, under the ope-
tion of the alembic, the crucible and other chemical processes, the
Materia Medica multiplies her agents, and the skilful practitioner mends
the constitution by making disease subservient to his art.

It has been urged by some persons (the number may be very lim-
ited) that it would be well to discard all articles from the Materia Me-
dica, except a dozen or two, and confine the treatment of disease to the
select few, and that success would then be as great as at present. Had
these persons maintained that all diseases might have been as success-
fully treated by them under such a system, we could not have dissented
from the proposition ; but to deny to medical men generally the benefit
of all new remedies, with a long list honored for their usefulness more
than for their antiquity, would be to deprive the indefatigable Dunglison
of a portion of his well earned reputation, and of the merit of much
valuable investigation and research, and to clip from the " Syllabus"
of our author some of his " family" arrangement, the proportion of
which could not be interfered with without depriving the student of
much valuable and concise information.

The outlines of the lectures before us are the production of a South-
ern man, but as their usefulness is not confined to sectional interest, the
student especially may peruse them, from the "Modus Operandi of me-
dicines," at the beginning, to the chapter on " Aliments" at the close
of the volume, with profit.

That there are no opinions expressed, and doctrines more than vague-
ly intimated in the volume, which might have been omitted without
prejudice to the fair name of the author, or without many lasting regrets
on the part of the reader, is more perhaps than Dr. Frost himself an-
ticipated, and more perhaps than the reader could justly expect, if he
consider that errors sometimes are but admonitions in disguise.

The views of the writer upon the " application of Cathartics to dis-
eases," will, we think, be received by a large portion of practitioners
with some reserve. In speaking of this class — Cathartics — our author
says, "In fevers of every variety they are indicated. ... In our bil-
ious grades of fever and in yellow fever they are invaluable. . . . Not
only in these fevers is the utility of Cathartics established, but even in
typhus, and the weaker forms of fever."

The author of the "Syllabus" will doubtless pardon us, if to some
of these propositions we raise an objection, and interpose brief com-
ment.

It will not be denied that the legitimate action of Cathartics is to

248 The New-Orleans Medical and, Surgical Journal.

operate as evacuants — frequently to the re-establishment of deranged
health; in such ease they have been "employed with some advantage;"
but the alimentary canal may discharge its foreign and foecal matter,
congestions may be relieved, and still often the fever does not abate.
Again, there may be a high state of cerebral excitement, with great
prostration of vital power, as sometimes exhibited in yellow fever ; or
there may be exalted sensibility of the whole prim te vise, with other
occasional symptoms of the same "grade" of fever ; and again in ty-
phus fever, the susceptibility of the intestines to the action of Cathartics
is greatly increased, especially after the incipient stage ; and yet we
are informed that " in these fevers," yellow fever, typhus, etc,., " is the
utility of Cathartics established."

As to "the weaker forms of fever," where the prostration of strength
is greater than occurs in typhus, and where, too, the pulse is often more
uniformly low, (for to such qualities only, we conceive, will "the weaker
forms of fever" apply) it is needless to dwell upon, no such fevers hav-
ing yet been classified.

In a book containing much that is assuredly useful, and which is in*
tended as a future guide to those whose lamps have not yet arrived at
full burning, we regret that Dr. Frost should have made such a sweep-
ing "application of Cathartics" to fevers, and that he should have com-
mitted so grave an error, or so singular an oversight, as to assert that
in the treatment of them " there is no remedy that can alone be de-
pended upon."

It were almost unnecessary at this late day to remind the lecturer,
(of which he cannot but be aware) that in most varieties of fever we
have a remedy of the highest utility, to those who employ it aright,
and upon which in an almost infinite number of cases we "can alone"
depend to shorten the duration and lessen the intensity of fever — we
refer to Quinine-— under the employment of which in no infinitessimal
doses, a high state of nervous excitability, with an exalted arterial ac-
tion, yield to the sedative, the diaphoretic and the anodyne influence of
this great agent. To fulfil the indications then in some of the types of
fever to which we have alluded, 20, 30 or more grains of Quinine, com-
bined or not, as the case may require, with from 2 to 4 grains of Opium,
with soothing or laxative enemata, will, by reducing the frequency and
volume of the pulse, causing sleep and powerful diaphoresis, be found
of the last importance ; and which, if neglected for a Cathartic or an
expectant course of treatment, will often render all medication unneccs^
sary ; for the patient, exhausted by excessive nervous irritability and a.
depressed vitality* sleeps in death.

Reviews. — Addresses, Reports, etc.

249

M The maximum dose," says our author, " varies much with different
practitioners — with ourself, the dose varies from one to five grains re-
peated;" a repetition from which it might reasonably be expected symp-
toms would " grow from bad to worse," for upon the authority of Dr.
Frost we are presently informed that " in small doses, (i. e. Quinine)
as ii or iii grains, it has produced an increase of thirst, headache, rest-
lessness, so much so, that it was necessary to discontinue it." If Dr.
Frost intended us to understand that it was to tender infants that he va-
ried the dose from one to five grains, we can only regret that he has
not so expressed it in the book ; its present reading does not even give
him the benefit of hope deferred, or construction falsified.

Dr. Myer, of Berlin, who has recently written upon the treatment of
Intermittent Fever by Quinine in (what is termed by that author) large
doses, states, that simple intermittent fever may be cured by a single
large dose (ten grains) of Quinine, but that in Heidelberg, where in-
termittent fever is neither endemic nor obstinate, from 40 to 120 grains
have usually been required in the ordinary treatment. Other European
and Continental writers are availing themselves of what they once
thought the temerity of American practitioners, with regard to Qui-
nine.

It must be borne in mind that in the latitude of Berlin, 53 ° , fevers
do not rage with the same degree of intensity, even if they are of the
same type, as in the low latitude of the Southern States, where long
continued and excessive solar heat are powerful excitants. We may
therefore consider 10 grains of Quinine in Berlin (relatively) as large
a dose as 20 or 30 grains with us.

Singularly at variance is this statement with the observations of some
medical gentlemen of Alabama. We refer especially to these, because
they are of the South, and because the doctrine and practice of the
writer, whose book in no unkind ness we are called upon to com-
ment, is intended for Southern as well as general teaching. In his re-
cent report to the Alabama Medical Society, Dr. Ames, after describing
a case of typhoid fever, in a black man, 22 years of age, which proved
fatal in five days, observes, " a dose of castor oil, which he had taken
previously to my visit, operated violently, and was followed by a diarr-
hoea more or less active while the attack lasted, the evacuations from*
the bowels, and also from the bladder, being made involuntarily."

Another passage equally to the point is found in the report of Dr. Cfi-
ley, read before the same Society. We quote only the closing passage
of his address. "The prevailing type of fever in this locality during
this year has, as usual, been remittent, of which we saw some exceed-

250

The New-Orleans Medical and Surgical Journal.

ingly stubborn cases. As a general rule in these cases, as well as in
intermittents, I have found Quinine more necessary to arrest the parox-
ysms than in previous years ; and in the treatment of all cases of fever
1 have been compelled to use Cathartics with the greatest caution, as
there was an almost universal tendency to hypercatharsis when they were
used. Indeed I have seen mild laxatives produce excessive purgation."

We have now endeavored to establish two points ; first, that the dose
of Quinine, from "one to five grains repeated, " which is the writer's
*' maximum" dose, is entirely insufficient to arrest speedily, even if it
will arrest at all, the generality of cases of fever occurring in this
Southern latitude ; with how much efficacy such doses of Quinine
might be employed in the fevers of Continental Europe, we have al-
ready shown.

Secondly — We have endeavored to point out, that " in fevers of
every variety" Cathartics (not even the mildest) are not. " indicated ;"
and that in typhus and typhoid fevers especially, their employment, as
a rule, is prejudicial.

If our author in some parts of his book, has expressed opinions at
variance with those entertained by a large and respectable portion of
Southern practitioners, and there could be much less objection to the
opinions expressed, than to the practice implied, we turn with pleasure
to the second division of the book, under which we first find Epispastics
dwelt upon somewhat in extenso. The principle of employing counter-
irritation, or of exciting action in one set of vessels and organs to re*
lieve others of a morbid state, is of ancient origin, the practice having
most probably commenced with the father of medicine. The substi-
tutes employed by the Greeks were irritating vegetables and powerful
caustics. " It was not," writes the lecturer, " until the science was
more advanced, that the more common practice, that of employing can-
tharides, came into vogue — their introduction into the Materia Medica
being attributed to Aretaeus, a physician of judgment and learning, who
flourished a little before the time of Galen."

The employment of blisters in the plague which prevailed in Italy in
the sixteenth century, gave rise to a more accurate knowledge of their
virtues.

In continuation of this subject we find the following judicious re-
marks : " In typhus fever blisters become very useful, when the powers
of the system show a tendency to prostration, where the contractions
of the heart become languid, and the patient struggles under anxiety,
restlessness, delirium, difficulty of breathing, etc. ... Of late the de-
lirium which so commonly attends in the advanced stages of this dis-

Reviews. — Addresses, Reports, etc.

•251

ease, has been considered as more effectually treated by blistering the
whole surface of the cranium."

In continued fevers Dr. Frost considers blisters inadmissible in the
commencement ; their use should be deferred until the action of the
heart and arteries has subsided.

Amongst the formulae which the writer has introduced in his work,
many will be found valuable ; but upon these we cannot enlarge.

The season is now approaching when Medical Colleges and their
worthy Professors will commence their campaign ; outlines of lectures
will then be of especial service. We trust the South Carolina Profes-
sor will meet the reward of his labor by a rapid demand for the fourth
edition of the " Syllabus."

Dr. Holland has sought to establish in his Address, with no small de-
gree of acumen and zeal, the importance of Pathological Anatomy, es-
pecially with the view of founding a separate chair for teaching this
branch in the Dublin University and in the Queen's College, Ireland,
so that she may not be behind her sister country and Continental cities,
which have long since acted upon the suggestions contained in the
Address. For the proper and successful study of Pathological Anat-
omy, the use of the microscope, and engravings of microscopical ap-
pearances, are strongly and justly urged, so that it may be made as
available in diagnosis and the successful treatment of a variety of dis°
eases, as it has already proved triumphant in renal affections. " The
presence of albumen in the animal fluids and secretions," observes Dr.
Holland, " has been found to play a most important part in modifying
our opinions of the causation of many diseases, and forms a leading
therapeutic indication. The name of Dr. Bright will be handed down
to posterity connected with this highly valuable discovery in renal pa-
thology, and he has pointed out the value of this symptom, in its rela-
tion to effusion into the serous cavities, especially of the arachnoid."
Hydatids have also been discovered in fluids obtained from tumors by
the aid of the microscope ; as well as half digested muscular fibre, and
biliary matter, showing that the abscess from which the fluid was taken
communicated with the bowel. Vander Kolk has observed, in the
Medico-Chirurgical Review for 1851, in the expectoration of phthisical
patients, the elastic fibres which surround the cells of the lungs ; under
a power of two hundred diameters they appear arched, very thin, with
sharp borders, at times covered with fat, which ether removes, and he
cautions us against confounding them with a species of conferva, which

252

The New-Orleans Medical and Surgical JournaL

forms rapidly in the expectoration, especially when it contains fat ; but
the ramifications of the conferva, terminating in tumefied cells, distin-
guished them from the elastic fibres, and these last are seen most cer-
tainly when the tubercles begin to soften ; this sign, therefore, is the
more valuable, as it is best marked when most required, namely, at the
early period of the disease,

A good knowledge of the subject of Pathological Anatomy is exhibited
in the Address before us, and the laudable desire to stimulate, and to
impart it to others, will doubtless be exhibited by the author in his lec-
tures at the Royal Cork Institution.

We must with all humility and candor acknowledge, that our medi-
cal friends of the State of Alabama have far outstripped us in assiduity
and labor, the evidence of which is the publication of the proceedings
of the Medical Association of the State, at its fifth annual meeting, in
neat pamphlet form of 130 pages.

The force of example is great ; we sometimes find it much easier to
imitate the works of others, than to be the original architects of an un-
defined course ; the mariner may fearlessly sail upon the expanse of the
ocean, but the pilot must safely direct his course to anchorage. Now
for the application.

Three annual sessions of the "Louisiana State Medical Society"
have been held in the city of New Orleans, the Presidents have deliv-
ered annual addresses, which have been pronounced very good, the
minutes have been " read and approved" in due form, and pamphlets
have been issued from the press upon authority, but where are the re-
ports of committees ? Few, very few have been made ; amongst those
which have been read, talent, research and industry were conspicuous:
but they for the most part found a resting place where no light shine ih ;
but with incentive to action before us we must apply ourselves to the
work, and send forth in hook form, after the next annual session, reports
full and complete, upon the subjects assigned to the committees. Coun-
try members will therefore bestir themselves, and with their zealous
aid we may hope to accomplish much.

But to the proceedings of the Alabama Association. Fevers and
Dysentery are the prevailing diseases of Alabama, as in fact they may
be said to be of the South western States, and upon these, with the
treatment employed, the reports are principally made. The papers are
practical in their character, and the observations of their authors judi-
cious.

Reviews. — -Dr. Meigs on the Practice of Midwifery

253

The treatment of that formidable and often intractable disease, Dys-
entery, has received much of the attention, as it has also required all the
skill of the members of the Association, to carry its victims to a success-
ful issue.

From the reports, we rind the Saline treatment to have been very
generally employed, and the success attending it has been good.
There are some, however, who from experience or not, are disposed
lightly to esteem the practice. Dr. Ciily observes, " Active and full
depletion, emetics, cathartics, particularly salines, anodynes, mercury,
astringents, quinine, ice and blisters, were all resorted to, but still the
disease ran its course, apparently uninfluenced by all our efforts." And
. again, after a depletive course and blisters, Hope's nitric acid mixture,
with some of the vegetable astringents, restrained the evacuations.

There is also a long paper upon Indigenous Botany ; and another,
which is well written, upon periodicity in disease.

The talent and industry displayed by the members of the Association
is highly commendable, and the diffusion of their labors, a commentary
upon the intelligence of a portion of the medical faculty of our sister
State, G. T. B.

II.— Obstetrics ; the Science and the Art. By Charles D. Meigs, M.
D., Professor of Midwifery and the Diseases of Women and Chil-
dren in Jefferson Medical College, etc., etc. Second edition, revised,
with 130 Illustrations. Philadelphia, 1852.

As this work was written avowedly for students, whose tastes it is
fair to presume are not yet fully formed, it is to be regretted that the
author did not, in issuing the second edition, correct the many defects
and blemishes which crept into his style in the first edition, some of
which we pointed out in our notice of the first issue. Although some
improvement in this respect may be observed, yet the composition of
the work is so tarnished with foreign idioms and Greek derivatives, that
the attention must be frequently diverted from the subject-matter, whilst
contemplating the learning, the research and the genius of the author.
For example, take the following sentence : " Either the ovarian stroma
is active and regular in the 'performance of its mensual physiological act
of ovulating, or else that a gravid state prevents the sign of the act from
becoming manifest." Such phraseology may be easily understood by

254

The New-Orleans Medical and Surgical Journal.

readers as learned as the author ; but as the book was written confess-
edly for students, certainly such have a right to be addressed in lan-
guage less ambiguous, moreB'simple, and free from every thing like cir-
cumlocution.

The vast learning and the great experience of Prof. Meigs are, in a
measure, sealed from the medical student, purely on account of the
style and manner in which he endeavors to communicate it to others.
In the foregoing remarks we have only thrown out some objections,
well founded, as we conceive, against the author's style : but we com-
mend the matter — the vast number of important facts — observations and
deductions, which are apparent on every page, from the beginning
usque ad jinem.

Our esteemed librarian,;T. L. White, 53 Canal street, has the work

for sale.

III.— The Principles and Practice of Surgery, By Wm. Periue, F.R.
S. E., Regius Professor of Surgery in the Marischal College, and
University of Aberdeen, Surgeon to the Royal Infirmary, etc. Illus-
trated by 316 Engravings. Edited with additions by John Neill,
M. D., Surgeon, etc., Demonstrater of Anatomy in the University of
Pennsylvania. Philadelphia, 1852.

The author of this work is, we believe, but little known in this coun-
try ; but this volume, when it becomes familiar to the student of Sur-
gery, will impress him with the good sense and sound practical views
of the author. Mainly designed, as all such works professedly are, for
the class of the University to which the author is attached, it is simple
in its arrangement, limited in its object, and practical in its bearings.
Without any pretensions to originality, it is yet quite a readable book,and
does not fall much behind such works as Druit's, Liston's, Malgaigne's
and similar popular volumes on Surgery. Dr. Neill has enriched the
work by the judicious selection of his notes. The book contains 770
pages, is well illustrated, and printed on good clear type.

T, L. White, 53 Canal street, has received the work.

Reviews — Dr. Boling on Quinine in Continued Fever.

255

IV.— On the Use of Quinine in Continued Fever. By W. M. Boling,
of Montgomery, Alabama.

This is the title of a paper contained in the Original Department of
the New Orleans Medical and Surgical Journal for July, 1852 ; and
one the practical precepts of which, if we are not greatly mistaken,
are better calculated to place in a favorable light before the profession its
distinguished author, than any thing we have recently read from his
pen. But notwithstanding this our unqualified commendation of the
performance as a whole, we are far frem considering it in detail as free
from blemishes, some of which, perhaps the more glaring, we will en-
deavor, in the course of the following brief notice, to set forth.

Being thoroughly impressed for some time past with the belief, that
there were not only one, but perhaps several varieties of fevers common
to the Southern States, in certain stages of which the employment of
Quinine was of rather doubtful efficacy — induced us, in a paper pub-
lished in the Western Journal of Medicine and Surgery for February,
1847,* to state that this " remedy, in the hands of those who enter-
tained different views concerning its operation, and who are in the habit
of prescribing it at the time of high febrile excitement, to the almost
entire exclusion of the lancet, the cold bath and mercurial cathartics,
were, in our opinion, doing more injury to the constitutions of their
patients, than ever resulted from the employment of any other vegetable
remedy ; why in the treatment of fever, where a furred tongue, nausea,
and torpor of the liver and bowels, with yellowness of the skin, exist to
a considerable extent, any good results should be expected from the use
of a remedy which does not evacuate in any visible manner, and which,
according to some, is a powerful narcotic — was to us passing strange."
Again, in the same article, (page 139) we observe that " so far as our
observation extends, in the inflammatory variety, the type being here
evidently continued, this remedy was seldom if ever admissible."
These views, at the time honestly entertained and candidly expressed,
as the result alone of personal experience, were considered by Dr. Bo-
ling of so doubtful a character, as to be made the subject, to say the
least of it, of quite an ungracious criticism ;f but having long since
ceased to smart under this worse than Russian castigation, and being
as yet without any reliable data, based on actual personal experience

* Remarks on the Pathology and Treatment of Fevers, page 128.
t Nev Orleans Med and Sur. Journal, pa<jo 752, SVtay No. 1847.

256 The New-Orleans Medical and Surgical Journal.

sufficient to warrant us in asserting that Quinine does possess the
power, in any sized doses, or mode of administration, of breaking up a
strictly continued fever — causes us at present to dismiss the subject, and
proceed, without farther preface, to what we consider the more objec-
tionable parts of Dr. Boling's paper, and in doing so have concluded to
let the Doctor speak for himself,

" There is considerable diversity of opinion among Southern physicians, as to the
effects of Quinine in continued fever, more especially typhoid fever, which within
the few years past has appeared to spread itself from the points in which it would
seem to have been long known, into others in which it had been but rarely seen.
One writer, for instance, R. F. Gibbs, M. D., of De Soto parish, Louisiana, in the 2d
volume of Fenner's Southern Reports, speaking of typhoid fever, remarks — From the
mixed nature of many of the cases which came under treatment, and the decided
periodicity, I was reluctantly impressed with the idea that Quinine would prove a val-
uable adjuvant in its early stages ; but after repeated trials in doses large and small,
I was forced finally to abandon it entirely, as not only useless in every case, but in
many cases decidedly prejudicial to the patient. A similar opinion we find frequently
expressed by others.

On the other hand, Dr. Thomas Fearn of Huntsville, Ala., speaking also in the 2d
volume of Fenner's Southern Reports of a continued fever, which he calls typhus,
the symptoms of which, so far as they are given, correspond very well with those of
the fever now known among us as typhoid fever, claims to have obtained much ben-
efit in it from the use of Quinine ; nay, even to have arrested its progress ; to have
at once cut it short in its course. He gave to an adult female three doses of 20 grains
each, at intervals of one hour.

For three or four years past typhoid fever has prevailed in Montgomery, so that at
no time, perhaps, or at least but for short intervals for that period, has it been entirely
absent from the place. ... In some cases the disease, as it appears with us, pre-
sents somewhat of an acerbative character, more so, it is probable, than it does at the
North."

Besides being here presented with three distinct varieties of continued
fever, in some of which Quinine proved curative, and in others entirely
useless, not to say injurious, we are also informed that within the last
three or four years typhoid fever has made its appearance in Montgom-
ery ; and that some of these Montgomery typhoid fever cases present
somewhat of an acerbative character, more so, perhaps, than at the
North. Now, as characteristic of this latter form of fever, according
to our understanding, (to say nothing of the intestinal lesions) one class
of observers contend for the red, watery eye, and low, muttering deli-
rium ; whilst another, equally as respectable, recognizes no fever as
typhoid that is not attended throughout, or a greater portion of it course,
with a loose state of the bowels ; whilst a third, and no le?s respecta-

Reviews — Dr. Boling on Quinine in Continued Fever.

257

ble and numerous party, look in this respect alone to the exanthema-
tous symptoms.

Although aware that Dr. Boling was not writing a history of typhoid
fever, nevertheless it is greatly to be regretted, that, in a matter of
so much importance, he should have failed to inform us whether these
Montgomery cases were recognized by either of the foregoing stand-
ards. To us the importance of this will be more apparent when we
state, that shortly after the subsidence of a reported epidemic of this
fever in Montgomery, for the purpose of getting something reliable in
relation to the matter, we addressed a letter of enquiry to Dr. Silas
Ames, one of the most experienced practitioners of that city, asking
him to give us the symptoms during life by which he recognized this
fever. To this letter the Doctor replied in substance, that as regarded
the diagnosis of typhoid fever, he depended upon the aggregate of the
symptoms in each case ; there being, as he believed, no certain or
special marks by which it could be recognized— -at least that he knew
of none.

Again, on page 2d—

" In cases in which the febrile excitement has been running high, the pulse fre-
quent, the skin hot and dry, and the tongue parched and pointed, with such doses of
the remedy as I have ventured to give, I have sometimes succeeded in subduing the
high excitement, reducing the pulse perhaps from 120 or 130 to 90 or 100, diminish-
ing the heat of the surface, rendering it indeed as also the tongue moist, and the pa-
tient's feelings and condition generally altogether more comfortable ; and this im-
proved condition I have seen maintained for days under the continuance of the rem-
edy, invariably, however, (with exceptions hereafter to be noticed, where there was
reason to believe that a favorable crisis took place independently of the effects of the
remedy during the time of its administration) the febrile symptoms have returned on
the suspension of the Quinine, and the disease has passed on through its course, ap-
parently unaffected by the temporary interruption in part of its progress, as if though
the remedy had exerted its usual controlling influence over the heart and arteries,
while continued, it was totally without power or efficacy to neutralize permanently,
or effect the elimination of the poison or particular cause of the disease from the
system."

With this candid admission of the utter inadequacy of Quinine to
cut short what we take to have been nothing more than a. case of ordi-
nary continued fever, prompts us again to hazard the assertion, that had
the excitement been somewhat reduced, the liver made to pour out its
bile, and the secretions unlocked generally, before its administration,
the result would have been probably quite different. To cure this va-
riety of fever, we must not only discover what becomes of the bile, but

258

The New-Orleans Medical and Surgical Journal.

find and dislodge it from the system, in the proper manner, and with the
proper remedy.

From topographical peculiarities, Montgomery has been, we believe,
from its first settlement, infested to a considerable extent with all the
grades and varieties of malarial fever. Among these, none perhaps
has been more prevalent than remittent fever ; that this variety, in the
person of those long resident in the locality, has, as in other places, for
several years been gradually undergoing a change, from the higher to
the milder grades, is to some extent doubtless true ; and that under
these circumstances, in the modified form in some constitutions that it
may present, we are not surprised in hearing of its being mistaken by
some for pure typhoid fever.

But perhaps the most singular feature contained in the paper under
consideration, is now to be noticed ; and that is the remarkable test of
Dr. Boling for determining the presence or absence of miasmatic and
typhoid fever, which is as follows (page 4) :

" But although I have never myself been able to cut short by the use of Quinine
an unquestionable case of typhoid fever ; and although it is now, 1 believe, pretty
generally the impression among such physicians of this section of Alabama as I have
conversed with on the subject, that it cannot be so arrested, it is more, whatever my
own belief, than I would be willing to assert, that it may not be done. I have never
myself given the remedy in typhoid fever to the extent that Dr. Fearn did in the
cases in which he succeeded with its use, though I have frequently given it in mild
cases without this effect, in doses, with which I am in the habit daily of arresting with
certainty and at once the most violent attacks of the various forms of miasmatic fever.
Either then my doses have been too small, or the disease now called typhoid fever
among us, is different from the cases which were treated with Quinine successfully
by Dr. Fearn, and which he calls typhus, notwithstanding the striking resemblance
between them ; and at all events, in both there is this agreement, that in their symp-
tomology they differ widely from any of our recognized shades of miasmatic fever.
Besides the name of typhus, which he gives his cases, Dr. Fearn speaks of the dis-
ease as continued fever. He does not speak, however, of the post mortem appear-
ances, and notwithstanding the resemblance, I am forced to the belief, that the dis-
ease in question was not the one now known among us as typhoid fever. I cannot
think it possible that this malady, when established in a recognizable form, can be
cut short by Quinine."

Who ever contended that it could be ? The mere assertion of a be-
lief, on the part of Dr. Fenner, that Quinine, if properly administered
in conjunction with Calomel and Opium, might possibly cut short the
disease, has nothing, in our opinion, to do with the belief that it is
" one of the protean forms of endemic malarial fever." True, to some,
extent the history of our malarial fevers are yet to be written ; but in

Reviews— Dr. Wood on the Practice of Medicine.

269

what particulars our common continved fever differs from the recognized
shades of miasmatic fever, is something, we must confess, that we have
yet to learn. Surely Dr. Boling would not contend for a change of
cause, on the mere loss of periodicity, and consequent change of type.
Once again and we are done, page 8 :

'^Everyone interested particularly in the subject, who reads the remarks of Dr.
Fenner, must regret that he did not give the grounds upon which his conclusion is
predicated, that (believing, as he does, that Quinine will cut short typhoid fever) it
must be given in the 1 forming stage,' ' within the first two days, or three at far-
thest, from the time the fever is perceived.' We are led to infer that it is not based
upon his own actual observation. [ How characteristic this of the writer ?] It would
seem inconsistent, too, with his belief in the connection or relationship of typhoid fever
with the « protean forms of endemic malarious fever,' [how ?] because not even in the
very worst forms^of these^would Dr. Fenner restrict the administration of Quinine
to the first three days, but with the utmost confidence of immediate success, would
resort to it in most of them at a much later period." [What worse forms ?]

In bringing to a close this hasty notice of Dr. Boling's very interest-
ing paper, we cannot but express the hope that he will shortly favor the
profession with a better diagnostic test of the presence of typhoid fever,
and reason that it is not of miasmatic origin, than his inability to cure it
with Quinine. J. C. H.

Wetumpka, Ala.

V. — A Treatise on the Practice of Medicine. By Geo. B. Wood, M.
I D., Professor in the University of Pennsylvania, etc. 3d edition, in
2 vols. Philadelphia, 1852.

This finished production has only been before the profession five
years, and has already reached its third edition — undoubtedly the high-
est encomium that could be passed on the labors of its accomplished
author, by any words that we might coin. As an American work, we
are proud of it, and can refer to it with feelings not unmingled with
national exultation. Except " Watson's Practice of Physic," where,
may we not ask, is the work, on the same subject, in the English, Ger-
man or French language, superior or equal to it? The rapidity with
which each successive edition, although large, has been exhausted —
scarcely allowing the author time to revise or amend it, answers the
foregoing question in a manner which must be as gratifying to the au-
thor, as we feel sure it is to his American professional brethren.

Over 80 pages of new matter has been added to this edition, embra*

260 The New-Orleans Medical and Surgical Journal,

cing notices of the relapsing fever of Jenner ; the leucocythema of Prof.
Benuet; the dengue; trichosis, lupus and pellagra. Besides the fore-
going, the chapters on inflammation, fatty degeneration, carcinoma,
cholera, phthisis, the nature of hemorrhage and Bright's disease, have
been meterially modified and made to conform to the wants of the pro-
fession and the present advanced state of medicine.

A work of this magnitude, reaching nearly 2000 pages, is too volu-
minous for any thing like a recapitulation of the views of the author ;
nor can this be deemed necessary, when the talents, erudition and repu-
tation of Prof. Wood are well known, and we are glad to perceive, so
justly appreciated.

The work is finished in beautiful style, and reflects great credit upon
the publishers. We hope every American physician who feels any in-
terest in our home literature, will supply himself with a copy of this ad-
mirable work ; it is invaluable to the general practitioner.

VI. — ThomcB Sydenham M. D., Opera Omnia. Ediclit Guiliemus
Alexander Greenkill, M. D. Editio altera. London!, Impensis
Societatis Sydenhamianse, 1851.

Through one of the "Local Secretaries" of this city— -Br. E. D. Fen-
ner, we received the "Opera Omnia" of the great and wise Sj^denham
fiom the London Society of the same name. The volume numbers
667 pages, in the original latin, is printed on superior paper, and is
bound in handsome style.

To review a work which has been before the profession for more
than two centuries, and during that time regarded as a model for accu-
racy of description and precision of language, would be as superfluous
as to attempt to expound the doctrine of the New Testament to the
devout followers of the meek and lowly Nazarene. Thomas Sydenham
achieved for modem, what Hyppocrates did for ancient, medicine; hence
he has been styled, in consequence, the English Hippocrates. His de
scription of disease is so graphic, and his deductions so judicious and
sound, that modern medicine, notwithstanding all its appliances, has really
added but little to the practical suggestions of this truly great physician.
To show the high estimation with which the writings of Sydenham
have been regarded by his successors, we cite the following from one of
his numerous annotators, Dr. Wallis:

Remei£s.—Di\ (jreex on Polypus.

261

"u Indeed so convinced have later times been of the validity and accuracy of his
descriptions, that they are considered as the unrivalled delineations of nature ; so
universally have they been esteemed for their exactitude and truth, that poets never
made freer use of, or stole more from Homer, Pindar or Virgil ; satyrists from Juve-
nal, Persius or Horace ; orators from Demosthenes, Quintilian or Cicero ; nor drama-
tists from Shakspeare, than physicians have from Sydenham."

The Sydenham Society of London has given, in the re-publication of
the " Opera Omnia" at once a guarantee of its great usefulness and
wisdom, and placed the entire profession, wherever respected and cul-
tivated, under obligations not likely soon to be liquidated.

VII.-— Oai the Surgical Treatment of Polypi of the Larynx arid (Pjdcma
of the Glottis. By Horace Green, A. M., M. D., President of the
Faculty and Professor, etc. etc. New York, 1852.

It is only by well digested and carefully prepared monographs that special diseases,
or those peculiar to particular organs or parts, are to be traced out and clearly de-
fined. Hence we approve the plan of the little work before us, because it points out,
in a few pages, the symptoms and peculiar nature of certain affections appertaining
to definite parts or organs, giving at the same time such statistical information as the
science of medicine furnishes on the subject. By this means, all the facts in relation
to a particular class of affections are brought out from the great mass of matter scat-
tered through thousands of pages, and condensed within a small space, easy of access,
and always available for practical purposes.

Professor Ehrmann of Strasburg, was the first, according to the author, to di-
rect particular attention to Polypi of the Larynx. This Professor has collected twenty-
six Cases of laryngeal Polypi, all of which proved fatal except one, which came un-
der the care of Professor E. himself. On this patient he performed the operation of
Jaryngotomy. We have already stated that the life of the patient was saved.

Professor Green informs us that he has operated twice for laryngeal tumors, and.
with complete success in both instances. One was for a Polypus attached to the
inner surface of the larynx, and the other a " growth of vegetating tumors," which
originated in or near the vocal ligaments. He saved his two patients without resort-
ing to the operation of laryngotomy.

Up to the time Professor G. turned his attention to this subject, less than 40 cases
had been reported of Laryngeal Polypi ; but during the last six years, the author has
himself met with four cases, and is persuaded that the disease is much more frequent
than is suspected ; first, because the diagnosis of these excrescenses is extremely dif-
ficult ; and second, the symptoms developed by their presence simulate those often
observed in asthma, phthisis, oedema of the glottis, thickening of the mucous mem-
brane of the larynx, and ulceration of the vocal ligaments.

Professor Ehrmann, who has given much time to the elucidation of this disease,

262 The New-Orleans Medical and Surgical Journal,

says, that " Polypi of the larynx, left to nature, become, sooner or later, the cause
of sudden death." From the situation of these growths or excrescenses, being, says
Dr. G., generally attached by a pedicle, either to the ventricles of the larynx or to the
cordae vocales, the morbid body may be concealed in the glottis, and remain, even
after the death of the patient, the undetected (and unsuspected, Ed.) cause of the fatal
termination.

Symptoms. Polypi in the larynx are usually marked by an altered voice, a dry
cough, sometimes embarrassment in the respiration. Later in the disease the voice
becomes hoarse at intervals; then continuously so, especially in damp weather; finally
dyspnoea supervenes, difficult respiration, complete aphonia, livid countenance, cya-
nosis and asphyxia, when death ends the agony of the patient.

The intelligent reader will readily comprehend the successive symptoms which
would attend the development and growth of such a morbid product in the laryngeal
passages ; and we shall not, therefore, enter into further details on this point. The
following is the description furnished by M. Ehrmann, of the morbid growth which
lie found after death in the larynx of a subject : " A fleshy excrescence was found?
lobulated, of the volume of a small nut, fixed, by the aid of quite a large pedicle, to the
whole extent of the left inferior ligament of the glottis. This tumor, soft, rounded,
quite smooth, obstructed completely the glottic chink. It was of a pale red coloi? ;
its consistence was similar to that of the fibro-cellular tissue ; and all its external tissue,
which was slightly nodulated, was continuous with the laryngeal mucous mem-
brane."

Polypi of the larynx are, happily for humanity, a rare affection, and if not promptly
met, in its early stages, will destroy the patient by closing up the epiglottic opening,
and producing death by asphyxia. These portions of the air passages may become
the seat of other morbid and anomalous growths, besides those of Polypi.

Professor Green reports an exceedingly instructive case of Polypus of the larynx,
for the relief of which he operated, having obtained a slender double hook, with a
long handle, a probe-pointed knife, with a strong handle, and a delicate slender blade,
in the following manner : " The patient," says Dr. G. , " was seated in a good light,
before an open window (the nature of the operation being first described to the intelli-
gent young lady) with her head thrown well back, and held firmly by an assistant in
that position. With the fiat handle of my knife I depressed the tongue, and when the
epiglottis was in view, I glided the double hook over the top of this cartilage, and a
liitle on its laryngeal face. This operation caused the patient to cough ; the tumor
was again brought into view, being attached by its pedicle to the left ventricle, or the
left vocal ligament, and I endeavored to catch it with the hooks, but it was so quickly
drawn back into the larynx, that Ifailed to do it." Finally, after the second or third
attempt, Dr. G. tells us he succeeded in catching the hooks into the top of the tumor,
when turning quickly the blade of the knife downward, he passed it over the left bor-
der of the glottis, and cut from behind forwards, and succeeded in dividing the pedicle
near its attachment, and thus brought the entire tumor out of the larynx. All the
distressing symptoms under which the patient had labored for years quickly disap.
peared.

Other cases, with cauliflower excrescences, were treated by the author by cauteri-
zation, and successfully.

Dr. Green is entitled to the encouragement of the profession, for calling special at-

Reviews. — Dr. Cart weight on the Fallopian Tubes.

263

tention to an operation but little understood, and hitherto much neglected. Want of
space restricts us to a short and imperfect notice of this very interesting little mono-
graph ; and the consideration of his chapter on oedema of the glottis, although highly
instructive, must be postponed to another issue.

The book is full of useful hints and valuable suggestions, and may be purchased of
8. M. Norman, 14 Camp street.

VIII.—" CARTWRIGHT ON PROBING THE FALLOPIAN TUBES.1'

In the late July number of this Journal there appears an article from the pen of
Dr. Samuel A. Cartwright, under the above title. Said article purports to be a pro-
fessional, a scientific reply to an article of mine, published some time ago in the
Charleston Medical Journal and Review, wherein I dared to differ with Dr. Cart-
wright in relation to the practicability of catheterizing the Fallopian Tubes.

In a professional point of view, 1 cannot condescend to notice Dr. Cartwright's
article. The course he has taken can only tend to sink the subject of our difference*
and I scorn to join him in thus degrading our mutual calling. As a personal attack
on me, his article is rendered impotent by its degraded style, and it excites my pity
for, rather than my anger against, my venerable enemy — for such he virtually de-
clares himself.

What a grave error have I hitherto labored under in regard to Dr. Cartwright !
How much disappointed am I to find, that the gray hairs which I have hitherto re-
garded as the honored emblems of his scientific research, are, alas ! but so many sym"
bols of his dotage. I would as soon have suspected Dr. Cartwright of any thing
else as of clothing a purely scientific subject in the vulgar garb of personal abuse
of those who might see fit to differ in opinion with him ; and I blush for shame to
see one who would have himself regarded as a very pillar of our house, thus sap-
ping its foundation, for the little purpose of gratifying a fit of anger altogether un-
warrantable and inexcusable.

Dr. Cartwright pretends not to know who I am. Alas, for the miserable subter-
fuge !! He dares not insult Truth by denying even a considerable personal acquain-
tance with me. No doubt he regrets our literary acquaintance. But my very pen
refuses to lend its ink to a further notice of this most pitiful quibble.

Dr. Cartwright intimates the intention on my part to impugn his veracity. Had I
deemed him capable of a falsehood, I should not have deigned to criticise his article.
I am sorry to find him so morbidly sensitive on that score. Had my criticism of his
article contained any thing which even savored of personality, it would never have
appeared in the pages of the Charleston Medical Journal and Review. The gentle-
men who conduct that Journal have too high an appreciation of their profession, as
well as too exalted a sense of personal honor, to stain their pages with such matter.
Dr. Cartwright's insinuation against, them is as unjust as it is unmerited. Their of-
fence to him consists simply in this : Their pages are ever open to honorable discus-
sion ; they know that the development of truth in science is impossible when only
one side of a question is allowed to see the li<rht.

Dr. Cartwright, in a note to his article, makes a charge against me in relation to

264 The New-Orleans Medical and Surgical Journal.

a criticism of one of his articles published by me in the November No. 1849, of this
Journal. To show how accurately Dr. Cartwright chronicles events, I copy my re-
marks entire from the Journal, and in addition to the same I do hereby positively de-
ny ever having been asked by the editor of this Journal to allow him to send to Dr
Cartwright a " proof copy" of my review. I was ashed by the editor to allow Dr.
Cartwright to reply to my review in the same number of the Journal in which my
review was about to appear.

I labored under the full and unqualified conviction, that Dr. Cartwright had al-
ready become acquainted with the contents of my review, and I expressed to the
editor my utter surprise that such should be the case, when the paper was as yet
but in the proof sheets — that Dr. Cartwright should even know that a review was in
press ; and I, at first, rejected the proposal of the editor, as unfair and unprece-
dented.*

After renewed and urgent solicitation on the part of the editor, I finally yielded
the point. How generous Dr. Cartwright proved himself, is evinced by his not only
neglecting to acknowledge the favor I extended him; but by his indulging in personal-
ities in his reply to my review.

From the New Orleans Med. and Sur. Jour, for Nov. 1849.

" Whilst our article was yet in the proof sheets, we received, through the editor,
a request from the author of the pamphlet, that we would allow him to reply to our
review in the same number of the Journal. This somewhat surprised us, for, apart
from its being (so far as we are aware) altogether unprecedented in the history of
journalists, it exhibited a familiarity on the part of the author, with our yet unpub-
lished article, quite unaccountable. However, our motives for reviewing were the
best ; we were more than willing to give the author every possible chance to defend
himself and his theory, and we acceded to the request."

But I have now and forever done with my venerable enemy. Henceforth it shall
be my pleasure merely to look on, with my brethren throughout the land, and grow
fat laughing at Dr. Cartwright as he goes crawling along the road to fame, seated
behind the " Filia nataJovis," on their mythological steed, with their Hartford con-
vert " following in the footsteps of his illustrious predecessors," and holding a pair of
bellows, ready to inflate the animal, in case of accidental suspension of respiration.

D. WARREN BRICKELL, M. D..

Near Natchez, Miss., July 19, 1852.

* A Word from the Editor. — From the above positive declarations it would
appear that the author of the paper and ourselves are at issue with regard to the
facts touching the controversy between himself and Dr. Cartwright- As it is
more a matter of memory than one of positive certitude, we are willing that the
author should state his recollection of the particulars of that affair. I would sim-
ply ask, how could Dr. Cartwright be expected to reply to the author's criticism,
without first seeing the proof sheets ?

We intend no injustice to any one, and as we have published Dr Cartwright's
paper, we are willing to render equal justice to Dr. Brickell, by publishing his reply.
But at this point the matter must drop. No communication from either party,
touching this subject , shall be admitted into our Journal.

Reviews.— Dr. Cartwright on the Fallopian Tubes. 265

As Dr. Brickell, in a note to us, " demands" the insertion of his rejoinder to Dr
Cartwright, we cheerfully yield to this " demand,'* and thereby discharge our duty
at once to our subscribers and to the author. Our readers must not forget that Dr.
B. was the aggressor in this controversy ; and if lie has been worsted in the ren-
contre, the fault certainly does not rest with the editor. We would advise him here-
after to act exclusively on the defensive, for in that case he will be sure to enlist, at
least, the sympathies of the profession.

In striving to render equal justice to all, we have unfortunately incurred the dis-
pleasure of both parties ; placed ourselves "between two fires," " front and rear,"
and we can neither retreat nor advance.

We embrace this occasion to express our sincere regret for the insinuation thrown
out in our last number against our very excellent and able contemporary, the
Charleston Medical Journal and Review. We endorse nothing that seems to reflect
upon the motives or partialities of the accomplished editors of that Review.

Jpari Jourtl),

MISCELLANEOUS MEDICAL INTELLIGENCE,

I. — Health of Natchez, Miss.

From the Annual Report of the Board of Visitors and the Board of Examin-
ers of the Natchez Institute, kindly furnished us by Dr. C. S. Magoun of that
city, we take the following brief extract in regard to the health of the pupils of
that place. The rate of mortality as here shown, is perhaps without a parallel
in vital statistics. Read it ; it is for the year ending July, 1852.

The mortality during the year has been 3 out of 619, or 1 in 206, less than
half of one per cent, it is believed that no death has occurred among the chil-
dren of any of the private schools. The number in these schools in the city
has been estimated at 400. If we take the whole number of children at school
in the city at (in the Institute 619, and 400 in private schools) say in round
numbers 1020, the mortality will be 3 in 1020, or 1 in 340, or less than a third
of one per cent.

Although the mortality among our infantile population cannot be considered
great, when compared with many other cities; yet, if contrasted with the above,
we must confess the balance is decidedly against us ; and we are utterly at a
loss to find a satisfactory solution of the question. We are unable for want of
the necessary data, to institute any thing like an accurate comparison between
the per centage of deaths among the children in our public schools and those
of Natchez ; yet we can but think we should suffer in the comparison. Ed.

11. — Atropine Externally in the treatment of Neuralgia.

Such is the activity of the vegetable alcali, that great precaution is required
in its application to the treatment of disease. Dr. Lusanna reports in the
Gazette Medicale de Lombardie, some experiments which he was able to insti-
tute with this very active agent. He reports two cases of facial neuralgia
which were promptly mitigated, and soon definitively cured by the external
use of atropine.

It may be used by the endermic and iatraleptic method. The skin being
previously removed by a blister, or what is still better, because more speedy,

Miscellaneous Medical Intelligence. 207

the ammoniacal pom-made of Gorndret, when the atropine is dissolved in a
small quantity of alcohol, then mixed with simple ointment and applied to the
denuded surface. In this way, M. Lusanna says, we may employ from ademi-
grain to a grain in the 24 or 48 hours. M. L. uses the following formula iatra-
leptically :

Atropine ] 5 centr.
Alcohol a 36 q. s.
Dissolve. Add Axungia 12 gramm. M.

This ointment he uses in the form of frictions over the part affected every
two or three hours, consuming a portion, the size of a pea each time.

III. -—Obstinate Nervous Hiccough.

In a case of persistent hiccough, after every variety of treatment had failed,
Dr. Marage hit upon the following formula, which promptly removed the affec-
tion :

E. Oil of sweet almonds, 60 grms.

Syrup of Diascordium, 30 '*
" Peppermint, 12 "
Chloroform g'^t- xx M.

Of this give a coffee spoonful every three hours.

{Gazette Medicate de Paris.)
We have seen small doses of the spirits of turpentine, say 10 to 15 drops,
given every one or two hours, on a piece of white sugar, put a stop to prolonged
and violent hiccough. Ed.

IV. — Colckicum in Hysteria and Chorea.

In both these nervous affections the tincture of colchicum has been tried
with complete success. Thirty drops of the tincture may be given every six
or eight hours until the convulsions cease*. (Ib.).

V. — How Tubercles are formed in the Lungs.

In a great work on Pathology, Prof. Kostlin, of Stuttgart, (as we learn from
the Gazette Medicate de Paris) draws the following conclusions on the nature
and cause of pulmonary tubercles :

1st. Tubercle results from an exudation of a peculiar nature ; its deposit is
due, sometimes to local causes, and sometimes to a morbid state of the blood.
The vessels which furnish the materials of this exudation are often* in a state of
hyperemia or stasia, but this is not constant.

2G# The KeW'Grleam Medical and Surgical Journal,

2d. A short time after this exudation, the substance of the tubercle becomes
solid* In its interior are developed nucleated elements united to each other by
an elementary amorphous matter — -beyond this inferior degree of organization,
tubercle never advances.

3d. Tubercle is ordinarily deposited between the tissue of the parenchyma
— but rarely on the surface of the lungs. The color of tubercle is sometimes
greyish and transparent, sometimes yellowish and opaque, but their composi-
tion is nearly the same.

4th. Softening is not necessarily a metamorphosis of tubercular matter ; it
is determined by a serous fluid, which is received from the surrounding ves-
sels.

5th. Softening of tubercle is not accompanied by any tendency to a higher
organization \ hence no purulent corpuscles are formed ; on the contrary, the
organization which existed is destroyed. Softened tubercle and pus — tubercu-
lar softening and a purulent abscess, are things essentially different.

6t.h. The cure of chronic tubercular concretions is effected by the dissolu-
tion of the elements in the amorphous mass, which becomes more and more
contracted. Yellow tubercle can only be cured either by partial or total soft-
ening. Here a cure is impossible, because the hyperaemic vessels which sur-
round the softened tubercle, deposit, instead of new tubercular matter, a more
organizable blastema. This change necessarily limits the work of destruction,
and announces a diminution or cessation of the tubercular deposition.

VI* — Is the Physician authorized to provoke premature artificial Ahortim to
save the Mother ?

A long discussion, in which some of the most distinguished medical savans
have taken a part, has been for some time going on before the Academie de
Medeeine, on the subject of artificial abortion. This controversy, for it has
already reached that point, grew out of a report entitled, " De V accouchement
premature arlificielP presented to the Academy of Medicine on the 10th Feb-
ruary, 1852, by M. Cazeaux.

The following, as we think, just conclusion, closes the report of M. C. on
the subject :

1st. It is in consequence of a false interpretation that the laws, both hu-
man and divine, relative to abortion, have been applied to abortion practised
with a conservative object.

2d. Let the laws punish crime ; but they cannot reach, without injustice,
an act accomplished with the purest intentions.

3d. Placed in the desperate alternative of choosing between the life of her
infant and her own, the female has, by the laws of nature, the right to decide
against her offspring.

4th. In this case the Physician may, and should sacrifice the infant, for the
safety of the mother.

Miscellaneous Medical Intelligence.

269

5th. Provoked abortion being much less serious for the mother than embry-
otomy, performed at the full period of gestation, the accoucheur may and ought
to give it the preference.

6th. Deformities, in which the pelvis may be found less than six centime-
tres and a half in its shortest diameter — hemorrhages which nothing can check
— tumors either in the hard or soft parts, which cannot be removed — are the
only indications which can call for provoked abortion.

7th. The physician should never decide upon a step of this serious nature
without the previous advice of several enlightened medical men.

( Jour, des Connais. Med. Chir., Avril, 1852.)

VII.-^-A new mode of administering Cod Liver Oil.

The April number for 1852 of the Journal des Connaissances Medico- Chi-
rurg., copies from an Italian periodical, 11 Raccoglitore Medico, a very simple
and economical means of administering cod liver oil. The oil is made to com.
bine with powdered starch or arrowroot, to which is added a small opiate. In
the first stage of treatment the patient is made to take six boluses every morn-
ing and as many in the evening. After a certain time the boluses may be in-
creased, because the patient is gradually habituated to swallowing them.
The author of the foregoing suggestion, Dr. Benedetti, has found that the cod
liver oil is much more efficacious when given in this than any other form. He
is disposed to attribute the virtues of the oil rather to its eminently nutritive
properties than to the iodine which it contains. Hence, the addition of pow-
dered fecula must enhance its restorative properties. Given in this combina-
tion, Dr. B. has found the oil much more acceptable to the stomach, and, as
already mentioned, serviceable to the patient

VIII r — Analysis of Jaclcson County Springs, at Lynchburg, Miss.

BY J. LAWRENCE SMITH, M. D.
Professor of Chemistry University of Louisiana.

These Springs are situated in the State of Mississippi, about five miles from
the town of Biloxi, and only half a mile from the eastern shore of Biloxi Bay.
The coast near these springs rises several feet above the surrounding country ;
whilst the plain, as it recedes from the sea coast, is beautifully undulating, and
presents a charming and picturesque view to the beholder. The situation of
these Springs, being nearly equi-distant from both New Orleans and Mobile,
must tend greatly to enhance them as a summer retreat for the invalid and for
those in search of pleasure and recreation.

We give the following analysis of these waters, as ascertained by Professor
Lawrence Smith :

270 The New-Orleans Medical and Surgical Journal.

Water colorless, even when kept for a length of time in bottles, provided the
bottles be well corked ; so soon as opened, the water begins to blacken, from a
deposit of sulphuret of iron ; the odor of the water is that of sulphuretted hy-
drogen, which the water contains in considerable quantity; the taste, that known
to belong to this class of waters. Specific gravity, 1,00082, Gaseous con-
tents in one gallon :

Carbonic Acid, 4,632 grains.

Sulphuretted Hydrogen, 0,481 "
Solid contents in one gallon :

Chloride of Sodium, 47,770 grains,
do. of Calcium, 3,882 "
do- of Magnesium, 4,989 "
Protoxide of Iron, 4,712 "

iodine, a strong trace.
Organic matter, a trace.
Chloride of Potassium, a trace.
Alumina, a trace.

The iron is doubtless in combination with both the sulphuretted and carbonic
acid gases, the excess of carbonic acid holding both these combinations in solu-
tion.

The medicinal virtue of these waters is to be looked for more particularly
in the oxide of iron and sulphuretted hydrogen, both of which exists in notable
quantities ; and it is therefore apparent that many chronic diseases might be
cured, or receive important alleviation from these waters ; as a bath, it could
» be applied with much advantage.

From the foregoing analysis, the intelligent reader will at once appreciate
the value of these waters, and be enabled to predict for them a high reputation.
It has been remarked, that for those diseases peculiar to, or endemic in a coun-
try, there are always indigenous to that climate, whether discovered or not, a
remedy, which, when properly applied, proves a -certain and speedy cure forsuch
diseases ; applying this rule then to the present case, may we not venture the
suggestion, that the virtues of these waters are such as are precisely adapted
to the removal of those morbid conditions, nervous disorders and enfeebled
states of the system, so often witnessed in the South, and so difficult to relieve
by the usual method of treatment?

The large proportion of iron held in solution by the carbonic acid gas, con-
tained in this water, must make it at once acceptable to the stomach and invig-
orative to the general system. In addition to the martial preparations men-
tioned above, the analysis by Dr. Smith reveals a large per cent of the chloride
of sodium — a salt of the last necessity to the wants of the economy, and with-
out which health and strength would perhaps be unattainable.

With the chemical composition of these waters before us, we can easily se-
lect such cases as would seem most likely to be benefitted by the free use of
these waters. In the meantime, we shall await with some impatience further
developments in their medicinal virtues. To our friend, Dr. Austin of this city,
we are indebted for the foregoing information in relation to these Springs.

P. S. Several cases of obstinate chronic diarrhoea and scrofula have been
recently entirely cured by the use of these waters. Ed.

Miscellaneous Medical Intelligence.

271

IX. — Kreosote in the treatment of Scarlet Fever.

The August number for 1852 of the Philadelphia Medical and Surgical
Journal contains a very instructive paper by Dr. T. E. Waller, on the use of
Creosote" in the malignant form of Scarlet Fever. After reporting several
cases, for the relief of which other remedies had failed, and which were promptly
cured by Creosote, he concludes as follows :

Open the bowels every other day with castor oil. or some mild aperient ;
apply cold or cool water and lard alternately to the whole body frequently ;
warm mustard bath, if necessary, and tepid water with vinegar; solution of
nitrate of silver, in the first stage, to the throat, once a day, and in the suppura-
tive stage, three drops of Creosote in twenty-four hours, until the discharge
abates; wash and gargle the throat, etc., with Creosote water, six drops to the
ounce, three or four times a day ; and for the hoarseness and dry state of the
larynx, before or during convalescence, give from five to ten drops of balsam
copaiba on a little sugar, three times a day. After the patient gets up, great
care is necessary to prevent taking cold, and the- diet should be light for at
least two weeks in most cases. The Pulv. Jalap Comp. will generally keep
down or remove dropsical effusion or anasarca, if that state supervene.

X. — Accumulations in the Rectum mistaken for the Head of a Fcetus.

The July number of the New Hampshire Journal of Medicine brings to us,
(says the Transylvania Medical Journal) an amusing article under the caption
of "A small Mistake," from Dr. Buzzell. We cannot refrain from presenting
to our readers the following extract, exemplifying the assertion with which the
Doctor set out, "that it is the easiest thing in the world for the best of people
to be mistaken, physicians not excepted." After detailing with some minute-
ness the previous indisposition of the patient, who appears to have been an un-
married female, about 20 years of age, the Doctor proceeds :

In the latter part of April she was taken with pains in the lower part of the
bowels, which resembled labor pains, and as she was so stupid herself as to be
unable to inform her friends what was her real situation, an elderly lady in the
neighborhood, who was often called upon as a forerunner to the Doctor, and
who would officiate in an emergency, was sent for. She decided at once that
the girl was in labor. She made an examination, felt "the child's head low
down," and the "waters had broke," etc. She advised that a physician be
sent for forthwith. A young physician was sent for, who, being informed on
his arrival that she had been in "great pain by spells," and that the " waters
had broke," the "child's head had been felt," etc., made a slight examination,
and not having a very good opportunity for examination, as the patient was
very restless, he concluded that the old lady was right, and that the girl was
surely in travail. Her pains, however, seemed to abate after the arrival of the
Doctor, and that was not regarded as any thing very strange, for a young wo-
man having a young physician present.

The waters came away periodically about once in six or eight hours. This
rather perplexed the physician, and after spending the night waiting for the

272 The New-Orleans Medical and Surgical Journal.

" pains to come on," the physician thought, as it seemed to be rather a peculiar
case, that it might be advisable to have counsel. I was sent for; but as the
messenger was informed, when he arrived in the village, that I was not at
home, another physician was sent for, who visited the patient. Upon an ex-
amination of the patient, this consulting physician pronounced it to be a case
of super foztation ; and after explaining the case to the family and attending
physician, he proposed to send fof a surgeon, in order to make an incision in
the patient's side, and extract the foetus therefrom." He advised also that a
justice of the peace should be sent for to administer the necessary oath on
such occasions, or in other words, " to swear the baby." The justice came in
due time, and as suspicion naturally rested upon the man at whose house the
patient had lived, as before stated, she was made to swear the baby on this man
— though the justice was not disposed, from the vagueness or indefiniteness
of her answers to his questions, to proceed to issue a warrant for the arrest
of the father of the child.

The case had now assumed a very serious aspect. The character of the
patient, and of a hitherto respectable man, was " down," and the news flew
on the wings of the wind, as might be expected in this newsy world. I was
sent for the next day. The messenger related to me the case as well as he
could, and requested me to take my instruments with me, and prepare for the
operation. I went to the scene of action, however, under the impression that
there was a joke about it. On making an examination of the patient, I found
that instead of its being a case of super foetation, it was nothing but a large
accumulation of faeces in the rectum, so large that it occupied nearly the whole
of the inferior portion of the pelvic cavity, merging forward hard on the pubic
bones and against the bladder. This explains the reason why the old lady
supposed that the " waters had broke." The urine escaped, of course, at dis-
tant periods, and then "with a rush." I directed the old lady, who had the pri-
ority in the call, to oil her fingers and cautiously to deliver the patieut of her
burden. I advised the father to stay process legally, until the child was born
and named, and concluded myself that I should consider it a hard case to be
the alleged father of such a child.

The patient is, 1 believe, as "comfortable as could be expected" under the
circumstances. I advised that her bowels might be kept pervious, and I be-
lieve that she has not had occasion to " send out" again. It would seem that
but a small share of common sense would have saved any man from such a
blunder; but as the physician who made the mistake claims to be a very sci-
entific man, I am forced to say that the saying quoted in the commencement
of this article is emphatically true. Such a case should admonish young
practitioners to be cautious and thorough in their examinations, and not to let
modesty prevent them from discriminating between a large accumulation of
fasces in the rectum and a child's head.

XI. — Treatment of Varicocele by Gutta Percha dissolved in Chloroform.

BY DR. H. G. CAREY.

After having used gutta percha considerably for other purposes, a knowledge
of its properties forcibly suggested it in solution, as admirably fitted to fulfil the
desired objects sought in the treatment of varicocele. Jn order to apply it, the
patient is placed upon his back, and by means of cold the scrotum is corruga-
ted until it is drawn firmly over the root of the penis, compressing the testes
firmly in the upper portion of the inguinal pouches ; then, by means of a cam-

Miscellaneous Medical Intelligence.

273

el's hair pencil, after the hair has been removed, apply the solution freely over
the site of the scrotum, allowing it to extend on all sides some distance by a
thin attachment ; but over the scrotum proper lay on a succession of coats, un-
til a thickness of a line uniform throughout is obtained, which will be suffi-
ciently strong to form an artificial pouch of the nature and character desired.
This thickness will be so yielding and pliable as not to afford the wearer any
considerable inconvenience. Soon after the solution is applied to this sensitive
part, the patient will complain bitterly of the burning sensation experienced,
depending upon the presence of the chloroform ; but this temporary inconveni-
ence will soon pass off. The constitutional indications, if there be any, must
not, of course, be neglected.

(Monthly Jour. Med. Science, March, 1852.)

XII — Diluted Hydro-cyanic Acid as a topical application in certain affections

of the Eye.

The above application is highly recommended bv Mr. Soliman in the Medi-
cal Times and Gazette, in certain forms of strumous opthalmia — often so per-
plexing to the surgeon. He uses one part of Scheele's Prussic Acid, diluted
with two parts of distilled water. Jt may be used with marked advantage,
when the acute stage, says Mr. S., has been subdued by appropriate treatment
or in cases where the symptoms of irritation are greater than those of vascular
excitement. The lingering chronic stage, with the liability to relapse, is
averted ; dimness of vision, intolerance of light, and profuse lachrymation
quickly yield to its calmative powers.

[Condensed from Braithwaite's Retrospect for 1852, by the Editor of N. O-
Med. and Sur. Journal.]

XIII. — On the treatment of Typhus and Typhoid Fevers.

BY DR. TODD.

One important feature of fever, whether it be typhus or typhoid, whether
diarrhoea be present or not, is depression. The disease is adynamic, and great
attention must therefore be paid to supplying the patient with a proper nutri-
ment. The basis of his diet should be proteinaceous matters, in such a state
that the stomach shall have little or nothing to do to bring them to a condition
fit for absorption. In the animal broths, well made, and in milk, you have food
which answers to this description. The former, on the whole, are probably the
best. Milk is less easily digested, and does not always harmonize with other
matters necessary to be given. Farinaceous matters may be introduced also
in small quantities. A great secret of success in administering support to pa-
tients under these circumstances is this — to give it very frequently in small
quantities — quantities so small, that the whole or greater part of one supply
may be absorbed before the next supply is brought ; and also not to give a va-

274

The New -Orleans Medical and Surgical Journal.

riety of food. Keep to milk and beef-tea, or other broth, or to broth and farin-
aceous matter.

In the great majority of cases you must, I think, give stimulants, and give
them early. They will often fail because begun too late. The best stimulants
are brandy and port wine, with either of which chloric ether will go as well
as a medicinal stimulant; any one of the three will often suffice alone. Port
wine and brandy ought not to be given together, simply because in general the
stomach does not digest well two kinds of stimulants. The same rule as to
frequent administration, and in small quantities, which I have already laid down
for food, holds with equal if not greater force in giving stimulants.

In my opinion, the question in the treatment of fever is, not whether you
shall give stimulants, but how much you shall give. In many you may give
as much as half an ounce every half hour, or even an ounce of brandy, with
advantage; but this is in bad cases. On this point you must be guided by the
rapidity and compressibility of the pulse, and by the intensity of the heart's ac-
tion. An important character of the pulse is found in the manner in which it
strikes the ringer ; if vacillating, it is a decided indication for the use of stimu-
lants. The strength of the heart's action, especially of the second sound, is
also a good indication. If either sound be weak, but especially the second, you
need not fear to give stimulants freely. An impulsive character of the heart's
action with a feeble sound, also denotes the use of stimulants. Under such a
plan of treatment, in which nutritious fluids and stimulants are given freely
and from an early period, we find our mortality in fever to be small ; we very
seldom lose a case of fever. I do not allow myself to be deterred from giving
stimulants by the state of the bowels ; I know that many have a fear that much
alcoholic stimulants irritates the bowels. If the alcohol be given in small
quantities each time, it cannot irritate it by direct contact, because it is ab-
sorbed before it reaches the intestines. Alcoholic stimulants, if not given too
much at a time, are digested in the stomach, and the alcohol gets immediately
absorbed and carried into the circulation. If it does harm, it does so from be-
ing in the blood ; yet I must confess I have never seen satisfactory evidence of
this.

We must also pay close attention to the bowels. If diarrhoea be present, it
must be checked by those astringents which contain tannin ; as the infusion or
tincture of rhatany, catechu, of matico, of logwood, or you may give enemata
with small quantities of laudanum. I find chalk often fails, and moreover it is
liable to this objection, that as it does not dissolve, its particles may add to the
irritation of the blood, by sticking in the ulcerated or inflamed patches. Coun-
ter-irritation over the abdomen by mustard, turpentine or blister, is also fre-
quently of great use. If there is hemorrhage, you may give small doses of
turpentine, five minims repeated every three or four hours, and in such cases,
turpentine must be used as an external counter-irritant to the belly.

Another feature in these cases is, the frequent occurrence of bronchitis or
bronchial congestion, indicated by rhonchus and crepitation. The bronchial
congestion and diarrhoea are frequently the most difficult symptoms we have
to deal with in those cases in which we find macular. The bronchitis may be
relieved by the free application of turpentine stupes or blisters to different parts
of the chest, at the same time or in succession ; and though in such cases we
must carefully watch the effects of our stimulants, we must not think of low-
ering our patient by bleeding, or By the application of anv antiphlogistic reme-
dies. (Medical Gazelle, 1851.)

Miscellaneous Medical Intelligence,

275

XIV. — To the Medical Profession of ike Southern and South-western States.

Gentlemen — At the last annual meeting of the American Medical Associa-
tion, I was continued as chairman of a committee, to report at its next session,
on the prevalence of Idiopathic Tetanus— (not endemic, as I was erroneously
notified by my first appointment). Permit me therefore to solicit your assist-
ance, to the extent of your information, either from personal experience or
enquiry, embracing the immediate circuit of your professional supervision.
Your attention to the following queries and answers, seriatim, forwarded by
mail to my address, on or before the 1st day of January, 1853. will not only
serve the special object of the Association, but particularly oblige,
Very respectfully, your ob't.,

A. LOPEZ, M. D.

1st. Are there any physical causes, in or about your locality, productive of
Idiopathic Tetanus ?

2d. Have changes by clearing of lands, change of culture, or any other cir-
cumstances, been the cause of such disease ?

3d. Has Tetanus been of frequent occurrence,* and if so, does it hold an
analogous or independent origin of malarious diseases ?

4th. Does it follow the laws which govern climatic endemics, in sufficient
number, and simultaneous prevalence, to warrant the belief of its identical
origin ?

5th. Have meteorological variations governed the production and character
of the disease ?

6th. The average number of deaths from Idiopathic Tetanus ?
7th. Have adults or children been most liable to its attack ?
8th. What sex ?

9th. Proportion of whites to negroes ?

10th. Duration of disease previous to fatality ?

1 1th. Interval between cause and development ?

12th. Does Trismus Nascentium ever observe an Idiopathic or symptomatic
character ?

13th. Are negro or white children most liable to it ?
14th. Your belief as to its origin ?
15th. Proportion of deaths to cures ?

16th. Have you found any form of treatment more successful than another,
in either Idiopathic Tetanus or Trismus Nascentium ?

276 The New-Orleans Medical and Surgical Journal*

£l)e 3TetD-©rleans fHctftcal anb Surgical Journal.

Vol. IX.] NEW-ORLEANS, SEPTEMBER 1, 1852. [No. 2.

HEALTtt, MORTALITY, &c.

We predicted, in some editorial remarks under this head in our last num-
ber, that Cholera, which was then prevailing to a considerable extent in ouf
city, would disappear in a few weeks. We are happy to state that that predic-
tion has been fulfilled almost to the letter, as will appear from the table which
will follow these observations. We were enabled to anticipate the course of
this disease in our midst, because we have had frequent opportunities to note
its steady, uniform and regular increase, after the few first cases, until it at-
tained its acme — which occupied from four to six weeks — at this point, that
is, the maximum of- deaths, it almost invariably stands about two weeks, when
it gradually and uniformly declines, until the deaths weekly number only some
three or four.

When the diease is revived and deaths begin to multiply among our popu-
lation, no atmospheric vicissitudes, however sudden— no thermometrical, elec^
trical or barometrical change, seems to exercise the slightest influence on the
course of the disease — it marches onward, claiming its victims here and there,
despite of sunshine and shower-— heat or cold-— the precautions of the timid
and the skill of the scientific. So in like manner, when the force of the mor-*-
bid principle is becoming exhausted, the disease as steadily declines, regard-
less of climatic influences and supposed favoring causes. This we have re*
peatedly witnessed, and so uniform is the Cholera in marching through these
three stadia, that we can speak With something like mathematical certainty
of its habitudes in this respect.

We subjoin the mortality for the nine weeks, ending Aug. 14th, 1852, in
New Orleans, as follows :

DEATHS IN THE CITY OF NEW ORLEANS,

For the 9 weeks ending Aug. 1 4th, 1852.

1852

Cholera.

Fevers.

Total

June 19th,

224

" 26th,

251

July 3d,

184

" 10th,

184

" 17th,

149

" 24th,

150

31st,

185

Aug. 7th,

133

" 14th,

126

Total,

314

197

1586

Editorial. — City Intelligence.

Of which number died under 10 years of age 564, and 220 colored — free and
slaves.

For the nine weeks, (see foregoing table) ending August 14th, the total
deaths were 1586, against 1855,-- -Cholera, 314, against 552; and Fevers. 197,
against 3 19, for the previous nine weeks, which closed June 12th — (vide July
No., 1852).

Both the totals and the deaths from Cholera have declined, as shown by the pre-
ceding table, since our July issue ; whilst the fevers have gradually increased —
an event that might be expected as the summer waned and autumn approached.
During the week ending August 7th, two deaths were reported as having
been caused by Yellow Fever ; but in the report of the succeeding week we
find none ; hence some doubts have been entertained among medical men as
to the reality of the disease in the two instances above mentioned ; but the au-
thority from which these reports emanated is too respectable and competent,
to justify any doubt as to the correctness of the diagnosis. Indeed, during the
current week (August 18th), we have heard of more than one case of black
vomit — a symptom universally admitted here as characteristic of the disease
at this season of the year. Up to date, not a case, bearing the slightest resem-
blance to this disease, has been admitted into the Charity Hospital — a fact
which induces many to hope and believe that our city will escape any thing
like an epidemic of Yellow Fever this season.

Whatever the future may bring forth, certain we are the city is at present
free of anything like epidemic or endemic disease, — on every hand— in every
section of the city — -from the extreme limits of one district to the outer verge
of the other, universal health prevails, and the prospects for the sons of Mscu-
lapius are any thing but flattering.

" THE MEDICAL RECORDER,"
Published bi-monthly by the Memphis Medical Society, at one dollar -per annum.

We have received this new medical periodical, which makes its appearance
under the fostering care of the "Memphis Medical Society." Two numbers
have already come to hand, and although too small to contain much matter,
yet it is quite neat in appearance, and reports several interesting cases of prac-
tical value. We trust the Memphis Medical Society, which contains so much
talent, will soon make the " Medical Recorder" both useful to, and popular
with, the profession.

278 The New -Orleans Medical and Surgical Journal.

RUPTURE OF SPLEEN, FOLLOWED BY AN ABSCESS IN THAT
ORGAN— ULCERATIVE PERFORATION OF THE WALLS OF THE
STOMACH, THROUGH WHICH THE ABSCESS DISCHARGED ITS

CONTENTS.

About the middle of June, 1852, an Irishman, aged about 35 years, entered
ward 12 of the New Orleans Charity Hospital, under our care. When he en-
tered, he presented the following symptoms : Countenance pale, face oedema-
tous ; pulse over one hundred, small, quick and jerking ; skin hot and dry ;
tongue pale and coated ; great thirst.

He represented that about ten days previously, whilst engaged on a steam
boat running on the Mississippi river, he accidentally fell from a considerable
height, striking his left side against a piece of timber. For several hours he
suffered great pain in the region of the spleen, which pain, however, in a mea-
sure subsided after a time, and he was enabled to walk about the boat until a
few days before his application to the Hospital, when the left side began to
enlarge and to pain him.

On inspection, we found the left hypochondriac region quite protuberant,
causing considerable deformity, and greatly increasing the circumference of the
lower part of the chest. The false ribs of that side were greatly elevated,
and pressure beneath them caused the patient great suffering. The lower part
of the thorax, nearly as high up as the nipple, was found quite dull on percus-
sion ; the surface about the parts presented no discoloration, no mark of contu-
sion, no trace of ecchymosis.

We diagnosed a possible rupture of the central or pulpy portion of the spleen,
succeeded by inflammation of that organ. The surface was sponged to reduce the
heat of skin; a large blister was applied over the region of the spleen, and small
doses of calomel and opium were ordered. The blister reduced the swelling
more than one half, diminished the pain, and we began in the course of a few
days, to anticipate a favorable result; but at our morning visit, at this time, we
found the pain had returned, with an increase of swelling ; patient restless ;
pulse quick, small avid feeble. A second blister was now ordered, the first
having healed under the use of mercurial ointment. The second blister drew
well, and gave but partial relief. In a few days from this time the patient began
to pass, per- anum, a dark, father foetid fluid, resembling grumous blood, or
rather stewed prunes ; this continued for two or three days, at intervals, in
spite of large doses of opium and acetate of lead, elix. vit., etc. The pulse
became extremely feeble and rapid, and the surface of a pale hue ; to this was
joined great restlessness, and despair on the part of the patient.

At this stage of the case the stomach became uneasy and nauseated; finally
vomiting took place, when large quantities of fluid, similar to that already
described as having passed per anum, were thrown up. Morphine, brandy,
soup and other roborants were freely given ; but the patient sank, and expired
quite exhausted with nausea and vomiting.

Editorial. — City Intelligence.

279

Post-mcJrtem after death. — Mr. Clark, a very intelligent resident student of the
Hospital, made the dissection in our presence. Nothing unusual was discovered
until we reached the spleen, which was large, softened and of the usual color.
On attempting to remove this organ, it was found firmly attached to the greater
curvature of the stomach. Continuing the dissection, we found the spleen
adherent, by compact, dense, cellular tissue, to the upper end of the greater
curvature, particularly about three or four inches below the cardiac orifice of
this organ ; in the centre of this point of adhesion, a communication had been
established, through an opening caused by ulcerative absorption, or rather
inflammation, into the walls of the stomach ; it measured at least one inch and
a half in diameter. Pushing our investigation a little farther, it was ascer-
tained that the centre of the spleen was the seat of a former abscess, which had
discharged a large part of its contents through the opening already described
in the walls of the stomach. The abscesses — the one longitudinal, the other
transverse, crossing each other thus, +, were well defined, and contained but
a small quantity of difluent, dark, fcetid matter. To sum up in a few words all
the material facts : The man fell — the spleen was either contused, or the
central, pulpy portion was lacerated by the fail, — vessels gave way, — blood was
poured out, but being in the central portion of the organ, it could not escape.
Too much to be taken up by. the absorbents, it was, in the course of time,
converted into a traumatic abscess. Nature, who is ever conservative in her
efforts formed adhesions between the spleen and stomach, at the most conve-
nient point of the latter ; the walls of the stomach gave way before the ulcera-
tive inflammation, produced by the pressure of the now progressive matter ;
through this opening the contents of the splenic abscess entered the stomach ;
the first was carried off by the bowels, but towards the latter part of the patient's
life, the matter became so offensive, that it was rejected by vomiting as soon as
it entered the cavity of this organ.

After death, we found a large quantity of dark, broken down pus in the
stomach — part of the contents of the splenic abscess.

POST MORTEM OF A CASE OF COUP DE SOLEIL.

On the 16th of August, 1852, a man, a little over the medium height, about
■25 to 30 years of age, of fair muscular developments, died of Coup de Soleil,
a few hours after admission into the wards of the Charity Hospital. The
usual treatment, such as revulsives to the extremities, cold lotions to the head,
<&c, failed to relieve him, and he soon expired.

The symptoms were such as usually attend these cases in the last moments
of existence. We may remark that he seemed conscious, ulthough unable to
articulate. He died late in the evening, and the post mortem was made the
succeeding morning by Messrs. Newsom and Waddell, resident students of
the Hospital, and the following morbid phenomena were noted by us at the time.

280

The New-Orleans Medical and Surgical Journal*

The entire surface of the body was pale ; no lividity or discoloration could be
detected. The expression of the face was calm, natural and rather composed
— items that should be invariably noted in cases of sudden death, brought on
by violent and overwhelming attacks.

The contents of the Cranium.— The scalp was not unusually vascular, except
in the occipital region, where position had produced its usual effects. The
dura mater was rather dry, transparent, and free from any abnormal vascularity.
The arachnoid was highly injected, and the pia mater presented a beautiful
mesh-work of injected blood vessels ; and this injection was continued into
all the sinuosities, sulci and convolutions of the cerebrum and cerebellum. The
cineritious structure, when divided, presented numerous bloody points, caused
by the escape of fluid from the divided vessels. The ventricles contained a
small quantity of serous fluid ; and when the medulla oblongata was divided,
as much as two or three ounces of colored serum escaped. In a word, the
entire brain, with its proximate membranes, were highly congested or in-
jected.

Thorax, Heart and Lungs, — On opening the chest, the pericardium was found
distended with fluid ; and when this sac was punctured, there escaped several
ounces — as much as six or eight — of bloody serosity. The right cavities of the
heart contained very dark, but not very firm coagula, commingled with a few
vellowish fibrinous concretions. The left lung, especially the lower half, was
loaded with dark blood, the air cells being completely blocked up, presenting
the appearance that organ does when in the first stage of approaching hepati-
zation ; when divided and pressed between the fingers, a dark, grumous looking
fluid, not unlike the bloody sputa in certain stages of pneumonia, escaped ; but
partial crepitation was discovered in any other than the upper portion of the
left lung under pressure. The same ramarks are applicable to the right lung.
A finer specimen of highly congested lungs is seldom to be met with, even in
the Charity Hospital.

The Liver. — This organ appeared normal, both in color and size; yet it seemed
more friable in texture than was consistent with healthy tissue. The exami-
nation ceased at this point.

Observation. — Upon what part of the organism shall we fix the first link of
that chain of morbid phenomena, which determines the ensemble of symptoms
characterizing an attack of coup de soleill Undoubtedly in the nervous cen-
tres, and chiefly in the encephalon, which, from insolation, conjoined with mus-
cular exertion, experiences a sort of paralysis of its dynamic force ; in conse-
quence of which, the circulation in the lungs and brain becomes deranged, —
both of these organs (constituting, as they do, two of the three legs of the
tripod of life,) the air cells become blocked up with black blood, and this state
of the lungs throws upon the brain, already struggling to unload its vascular
structures, additional embarrassments, from which, in the majority of cases, the
best directed efforts of the physician cannot extricate the unhappy patient. In
some cases, a spurious sort of reaction takes place: the pulse rises and becomes

Editorial. — City Intelligence.

281

full ; the skin burning hot, although often moist about the head and chest ;
whilst the feet and hands remain cool. Others again manifest no signs of
reaction ; the surface remains cool and pale ; the nervous centres, but chiefly
the brain, continue, so to speak, paralyzed, from the intense action of the mor-
bid cause.

In the first case bleeding would seem to be required ; but this practice must
be adopted with the greatest cautiou ; local depletion alone can be relied on, in
such instances ; and in many cases whilst cups are being applied with the one
hand, we must administer brandy and carbonate of ammonia with the other.
In the administration of fluids, in cases of sun-stroke, we must be cautious,
lest, in consequence of the partial or total paralysis of the muscles of deglutition,
we strangle the patient, as we have witnessed more than once in practice.
Active emetics, such as the sulphate of zinc and powdered mustard, in the early
periods of the attacks, particularly when preceded by a hearty meal, may assist
powerfully by unloading the stomach, in hastening reaction of the nervous
centres, and thereby restore the balance of the circulation. In coup de soleil,
the par vagurn, in common with the nervous centre from which it springs,
participates in the loss of function, and fails to transmit to the lungs, stomach }
&c, that amount of nervous influence requisite for respiration and digestion.
Vide Wilson Philip on the Vital Functions.

In cases attended with a full pulse, cool skin and general adynamia,
revulsives, general and local, stimulants internally and warmth externally, are
the means to be relied upon.

We had much to say on this subject, but our space is exhausted, and we
must close, trusting that some of our correspondents may turn their attention
to this interesting subject.

OUR MEDICAL SCHOOLS.

The season is rapidly approaching when the medical schools scattered over
our great and prosperous country, will throw open their doors to receive hun-
dreds, yea thousands of medical students within their walls. Circulars,
" announcements," &c.,are pouring in upon us from nearly every state in the
confederacy, each claiming peculiar advantages, either on the score of locality,
or the reputation of the professors ; and not a few found the claims of their
schools upon the cheap rate of board, and the yet cheaper price at which the
tickets of the Professors may be obtained. From such a number of schools —
all striving to swell their list of matriculants, the student finds it no easy task
to make a proper selection — he hesitates — he enquires— again lool& at the board
bill, the Professors' fees, and lastly, the expenditure for a diploma. Not un-
frequently this latter item determines his course— either to the North, East,
West or South — any where to economise — to be made a doctor on the cheapest
terms.

282

The New-Orleans Medical and Surgical Journal.

Our advice (which is gratuitous) to students is this : Let those who are of
the North and East, and especially those of them who intend to practice their
profession in those latitudes, remain at home, attend the lectures of their own
schools, which are numerous, well conducted, and many of them richly en-
dowed, and they will acquire all the elements of a sound medical education,
and thus be qualified to enter upon the duties of their profession. Those who
are reared, or who expect to practice in the South or West, should patronize
their own excellent schools — of which there are many — where they can acquire
not only the fundamental principles of their profession, but will likewise be
made acquainted with the diseases peculiar to the South, and the remedies
adapted to their cure ; and obtain that kind of knowledge which will enable
them to grapple successfully with our peculiar forms of disease. Students of
medicine must remember, that schools alone cannot make good Physicians,
although we grant they can manufacture Doctors without limit; upon his own
efforts, mainly, the student must rely for that knowledge and experience which
can alone guide him safely through the devious paths of a professional life —
upon his almost unaided exertions he must build his hopes of future eminence
and high renown. Neither the reputation of distinguished Professors, nor the
fair fame of our Alma Mater, can supply the want of information in times of
trial, doubt and danger ; upon all these he may call in vain — they will but
mock his fears, and justify his doubts, if he has failed to treasure up the requi-
site knowledge, and to apply his mind honestly and earnestly to the study of
his profession, after he shall have finished his collegiate course.

Young gentlemen, we repeat, patronize your own schools, and never venture
to travel a thousand or fifteen hundred miles to find a medical school, when the
same means of acquiring medical knowledge are within a few miles of "sweet
home."

ON THE USE OF ARSENIC IN HOOPING-COUGH.

BY A. R. NYE.

Assistant Surgeon N. O. Charity Hospital.

In the 14th No. of Ranking's Half Yearly Abstract, will be found an article
by Dr. McKenzie of London, on the "Nature and treatment of Hay-Fever."
In this article Arsenic is not only highly recommended in hay-fever asthma,
chronic catarrh and opthalmia, but its use in hooping-cough is thus spoken of:
"For upwards of three years I have given Arsenic in hooping-cough with the
most salutary effect. In general, it has put a stop to the disease in about a
fortnight, and it has never failed to moderate it in a few days."

If hooping-cough (as some maintain) depends upon a morbid state of the
nerves, of the respiratory mucous membrane, characterized by peculiar irrita-
bility of that membrane — then Arsenic is particularly indicated, from its well
known efficacy in analogous cutaneous diseases, Its utility in correcting and

Editorial. — City Intelligence.

283

controlling irregular nervous action, and the conditions dependent upon it, is
fully established in cases of lepra, psoriasis, and other skin diseases. However,
it is not my intention to support any favorite theory, but merely to give a history
of two cases of hooping cough, which have come under my own observation.
In both cases, I have no doubt, that the duration of the disease was much
abridged by the use of Arsenic. For it will be seen that the first case, which
was attended to early, lasted only a little over three weeks ; and the second,
which was seen much later, and was also a very severe case, lasted only a
little over six wTeeks. The usual duration is from six to ten weeks. Physi-
cians generally believe that it will run a definite course, and are merely con-
tented to combat complications as they arise. If any remedy can be found to
cut short this distressing disease of childhood, about 8 per cent of the deaths
before five years of age will be avoided — estimating from the bills of London
mortality. In that metropolis, pneumonia, hydrocephalous and convulsions
alone outrank it in fatality.

Two cases are insufficient to establish a fact ; therefore I hope to see the
experience of others on this subject.

case no. 1.

April 23d, 1852. I was called to see a female child, a year and a half,
robust and healthy, with the exception of the hooping-cough. She had had the
catarrh characteristic of the first stage, for ten or eleven days, and had taken
the usual domestic remedies. She had hooped only twice, previously to my
visit. Auscultation revealed nothing but a slight sonorous ronchus beneath the
right clavicle. During the examination it had one of its paroxysms of cough -
ing, accompanied by the characteristic hoops. The fit of coughing was neither
long nor very severe. As there was no evidence of inflammation about the
lungs, I determined to try Arsenic, and accordingly prescribed —

I£ Liq. Potasas Arsenitis gtt. xxv

Tinct. Opii, gtt. xx

Aq. distil. I ij M. et S.

Tea spoonful thrice daily.

April 29th. The paroxysms of coughing had diminished in frequency and
severity ; the bowels being costive, I directed the medicine to be discontinued
for one day, and a purgative to be administered.

May 4th. The parents informed me that the hooping had ceased on the 1st
inst. The cough had nearly disappeared. I directed the medicine to be con-
tinued for two days.

May 6th. The cough had entirely ceased ; the child was, apparently, per-
fectly well. I discontinued the medicine, ordered a purgative, and directed the
parents to avoid exposing the child to sudden changes of temperature for several
days. Its cough never returned.

case no. 2.

April 21th, 1852. I was summoned, in haste, to visit a male child, two and a
half years old, supposed to be dying from a severe paroxysm of hooping-cough

284 The New-Orleans Medical and Surgical Journal.

When I reached the house, I found the patient recovering, but leaving terrible
traces of the recent attack. The face was still swelled, and of a livid hue ;
the eyes were starting and injected; a slight mucous expectoration and vomiting
had followed the paroxysm. In half an hour after my arrival the little sufferer
had entirely recovered, asked for food, and returned to his amusements. He
appeared perfectly well. Auscultation disclosed a very little coarse crepitation
in both lungs. He had had the catarrh cough for 15 days, and the characteristic
hoop for 5 or 6 days. I prescribed :

I£ Liq. Potassae Arsenitis 3 ss

Tinct. Opii gtt. xx

Aq. Distil % ij M.etS.

Tea spoonful three times daily*

April 29th. The parents think that the paroxysms are not quite so severe
as they have been. I ordered the medicine to be increased to one tea spoonful
four times daily.

May 5th. 1 found the child much better. The paroxysms had greatly dimin-
ished in severity, and somewhat in frequency. I ordered the medicine to be
discontinued for one day, and then to be given three times daily in the same
dose*

May 10th. The coughing fits were not half as frequent as they Were ori-
ginally, and they were not always attended by the hoops. I discontinued the
medicine for one day, and gave a purgative.

May 11 (h. The hoop had disappeared, and a slight cough alone remained. I
ordered the medicine to be continued until the cessation of the cough, and gave
the same general directions as for Case No. 1. I met the father a few days
after, who told me that they continued the medicine for three days after my visit,
and that the patient had been perfectly well from that time.

BALTIMORE COLLEGE OF DENTAL SURGERY.

On the advertisement sheet of this number will be found the 13th annual
announcement of the Baltimore College of Dental Surgery — an institution
which has achieved much for the reputation and scientific knowledge of the
dental art. Our object is to call the attention of those who may wish to prac-
tice this profitable branch of the profession, to the superior advantages presented
by this school for the attainment of both the theoretical and mechanical part
of the profession. The faculty is composed of gentlemen of high attainments,
of liberal education, and every way qualified to prepare the student of dentistry
for the practical duties of life. We refer to the circular.

Edilorial.-^Cily Intelligence. 285

AN ANALYTICAL REPORT OF TAB UNITED STATES MARINE HOSPITAL,

FOR SIX MONTHS ENDING JUNE 30, 1852. BY P. B. Mc'KELVEY, SURG.

| Discharged in

Discharged

ill

DISEASES.

1 May.

j June J

g ) DISEASES.

f —

.,5

§*

j June J

12) Brought up -

406

A iZfl ("PC _

1 1

4) Necrosis Tibia

2) Orchitis -

2> Opthalmia -
2/ Paralysis, partial
2( Phthisis pulmonalis
5^ Pneumonia typh.
1) Paronychia -

1 1

Anlrlp Snrflin.

3! 2

• A_llcLS8XC<i

Bronchitis -

6 4

20) Pleuritis -

1 0

2) Rheumatism -

x>uuu

l) Rubeola -

VuUlUialUU

18? Radius, disloca. of
3? Syphilis -

■ChiSHhSain -

142

Cataract

l( Spine, Injury of

Carbuncle -

4( Scald

Condylomata

0! 2

3) Strict, of Urethra

f! Jin! Ara A cTih

0i 0

3j Scrofula -

Colic, Bilious

3; Ulcer -

" Piet.

0] 0

2) Variola, confluent

Disrrhnpjt —

1012

916

65? Wrist, dislocation

o°

Dysentery

2 1 Wound, contused

]

Debility, gen*

4( " incised
1C " punctured

Del. Tremens

Erysipelas -

l«Vvpr 3ntprm

-A. l/Vuij UUvllu*

97) Total -

—

2016

829

118

130

151 110

111

151

771

remit.
« typhoid

2
2

12
3

2
5

3j
I

29)

2qS died or

*' Chagr.

5( Abcess of Liver

Fracture, Rib

2^ Cholera Asphyxia

" Leg-

2S Diarrhoea

" Clavicle

8; Dysentery

Fistula in ano

1 ) Fever, typhoid

Gonorrhoea

46) Gastro-duodenitis

Oastrodynia

3/ Hepatitis Chronic

Hydrocele -

0 0

1/ Heart, disease of

Hernia -

2? Hydrothorax -

Hepatitis, chr.

1( Phthisis Pulm. -

Hyper, spleen

2( Pneumonia -

Iritis -

li 2

13) Peritonitis

Intemperance
Neuralgia -

3) Suicide -

■

3) Spine, Injuries of

Carried up

56 66

545093406!? Total -

RECAPITULATION.

Remaining in the Hospital, January 1st, 1852. - 99
Admitted to July 1st, - 807

906

Discharged to July 1st, - - - _ - 773
Died - 36

809 809

Total Remaining July 1st, 1852. 97

280 The New-Orleans Medical and Surgical Journal.

ABSTRACT OF A METEOROLOGICAL JOURNAL FOR 1852.
BY D. T. LILLIE & Co., at the City of New Orleans.
Latitude, 29 deg. 57 min. ; Longitude, 90 deg. 07 min. West of Greenwich.

COURSE

FORCE

Quantity

WEEKLY

THERMOMETER.

BAROMETER.

OK THE

OF THE

WIND,

Numb
Rainy

RAIN

WIND.

Ratio

1853.

Max.

Min.

Range.

Max.

Min.

Range.

1 to 10.

Inches.

June 24

93 .0

76.0

17 .0

30 .15

30.05

0.10

2.30

0.155

July 1

« 8

93 .0

75.0

18 .0

30.12

30 .05

0.07

SE.

2.58

0.820

93.0

76.0

17.0

30 .20

30.10

0. 10

2.00

1.005

« 15

92.5

74 .0

18 .5

30.15

30 .05

0. 10

NE.

2.50

0.330

« 22

91.0

74 .0

17 .0

30 .18

30.08

0.10

NNW.

2.90

4.755

« 29

93 .5

78 .0

15.0

30.13

30.08

0. 05

SE.

2.40

0.895

Aug. 5
" 12

95.0

79 .0

16.0

30 .10

30.05

0. 05

s.byw.

2.30

0.555

92 .5

74 .0

18 .5

30.15

30. 00

0.15

NE.

2.57

0.155

« 19

90 .5

75 .0

15.5

30.20

30 .00

0.20

NNW.

2.50

0.320

The Thermometer used for these observations is a self-registering one, placed in
a fair exposure. Regular hours of observation : 8 A. M., 2 P. M., and 8 P. M.

CHARITY HOSPITAL,
port for June and July, a£g§2,

Admissions - -

Males

Do. ...

Females

Discharges - -

Males

Do. .--

Females

Deaths - - -

Males

Do. ..-

Females

SEX.

JUNE.

988
422

791

349
,i

142
71

•1410

1140

213

JULY.

1141

387
— -1

982
349
_ ;•]

100

•1528

1331

133

There were 13 births in the Charity Hospital in June, and
21 in July.

There were 102 deaths from Cholera in June and 26 in July.
One case of Yellow Fever, the first one this year, died in the Hos-
pital on the 20th August.

JUSTIN V. LOUBERE,

Assistant Clerk.

THE NEW-ORLEANS

MEDICAL AID SURGICAL JOURNAL.

NOVEMBER, 18 5 2.

Part fixst;

ORIGINAL COMMUNICATIONS.

L— REPORT ON THE MEDICAL BOTANY OF THE STATE OF

LOUISIANA.

BY JOSIAH HALE, M. D.

(Concluded.)
Order, Ericaceae. The Heath Family.
Andromeda arborea, L. (Sowerwood, Sorrell Tree.) A rather
small tree, bearing panicles of small, urn-shaped flowers ; the leaves
and wood are a fine agreeable acid, cooling and refreshing. (Raf.)

Kalmia hirsuta, L. Grows in Louisiana. (Riddell.) The leaves
are used by the negroes and poor white people of South Carolina, for
itch, and the mange in dogs ; a strong decoction is applied to the erup-
tion. (Porcher.)

Azalia nudiflora, L. (Coral Honeysuckle.) A handsome shrub,
common along streams ; flowers in February. Cotter says the blos-
soms are made into fragrant conserves at the North. (Raf.)

Vaccinum arboreum, Marshall. (Farcle-berry.) A large shrub ;
fruit astringent, but well flavored, frequently remaining on the tree
through the winter. Bark of the root astringent ; used, like the ber-
ries, in diarrhoea and dysentery.

288

The New-Orleans Medical and Surgical Journal.

V. frondosum, L. (Huckle.berry) and several other species; fruit
useful in diarrhoea, scurvy, etc. Leaves astringent ; a tea used for sore
mouth. (Raf,)

Cyrella racemiflora, Walt. A large shrub, growing around ponds,
Covington. The outer bark of the elder shrubs, near the ground, is
extremely light and friable, and absorbs moisture with so much avidity,
that it may be used with advantage instead of agaric and similar styp-
tics. When rubbed between the hands, it excites a sensation similar
to that produced after immersing the hands in a strong astringent fluid.
It forms a serviceable application to wounds or ulcers, when the indi-
cation is to cicatrize them. (Ell.)

Monotropa uniflora, Ell. (Indian Pipe.) Plant white, turning black
on drying. Used by the Indians and herbalists. Juice mixed with
water deemed a specific lotion for sore eyes. (Raf.)

Order, Aquafoliaceae. Holly Family.

Ilex opaca, Ait. (Holly.) Properties similar to those of I. aquifo-
lium of Europe. Diaphoretic, emetic and cathartic. (Grif. Medical
Bot.)

I. vomitoria, Ait. A handsome shrub, like most of the genus, with
shining evergreen leaves, and persistent scarlet berries. The Indians
considered it a holy plant. The leaves, toasted and boiled in water,
form the " Black Drink" of the Southern tribes ; they employed it in
their councils to purge their bodies of all impurities. In small doses it
acts as a diuretic ; in larger quantities, it produces copious discharges
from the stomach and bowels.

I. prinoides, Ell. (Winter-berry.) The bark is astringent and
tonic.

Prinos ambiguo, Ell. P. laevigata, P. verticellatus, L. (Winter-berry.)
Bark tonic and astringent ; used with advantage in diarrhoea, and as
a corroborant in dropsy, etc.

Order, Ebenaceae. Ebony Family.

Dyospyrus Virginiana, L. (Persimmon.) The fruit, in this climate,
is large and delicious ; a good beer is made of it. The bark is tonic
and powerfully astringent, advantageously used in bowel complaints,
and as a gargle in ulcerated sore throat. The unripe fruit has been
highly recommended by Dr. Malacca (American Journal Med. Science,
October, 1842) as an astringent, in the form of infusion, syrup and tinc-
ture, in various forms of bowel disease, and in hemorrhage. (Grif.)

Dr. Hale on the Medical Botany of Louisiana. 289

Styrax grandifolium, Ait. S. glabrum, Ell. S. pulverulentum, M.

All abound in fragrant juice ; this, in two foreign species, when in an
inspissated state, is officinal, under the name of Storax and Benzoin.
(Grif.)

Hopea tinctoria, L. Hir. (Sweetleaf.) A rather small evergreen
tree. The root is bitter and aromatic, and is esteemed as a valuable
stomachic. The leaves have a sweetish taste ; they are used for dying
woollens and silks of a yellow color.

Order, Sapotaceae. Sapodilla Family.
Bumelia lanuguinosea, M. ; lycioides, Ell. The bark is austere, said
to be useful in bowel complaints; fruit black and unpleasant to the
taste.

Order, Primulaceae. Primrose Family.

The plants of this order are rather beautiful objects of culture than
valuable articles of the Materia Medica.

Samolus florabundus, Kunth. (Water Pimpernel.) Said to be an-
tiscorbutic, aperient and vulnerary.

Lysimachia ciliata, L. L. Carpenterii, Riddell. (Loose-strife.)
Subastringent.

Dodecatheon integrifolium, Nutt. Fragrant.

Order, Plantaginaceae. Plantain Family.
Plantago major, L. (Plantain.) This plant is now believed to pos-
sess but feeble powers, and consequently is rarely given internally. As
an external application it has been recommended in ulcers of various
kinds, and in indolent scrofulous tumors. (U. S. Disp.)

Order, Orohanehaeceae. Broom- rape Family.
Herbs destitute of green foliage.

Epiphegus Virginiana, Bart. (Beech-drop.) Bitter, astringent.
The powdered root acts as an escharotic in inveterate ulcers. Sup-
posed to be especially efficacious in those of a cancerous character.

Order, Bignoniaceae. Bignonia Family.
Tecoma radicans, Juss. (Trumpet Flower.) A shrubby vine.
Leaves sweetish, acrid, depurative. Used with Stillingia,for yaws and
to cleanse the blood.

Bignonia capreolata, L. (Cross Vine.) The root and vine, in infu-
sion, answer the purpose of Sarsaparilla. (Porcher.)

Catalpa cordifolia, Ell. (Catalpa,) The bark is said to be vermi-

290

The New-Orleans Medical and Surgical Journal.

fuge. A decoction of the pods has been recommended in pectoral com-
plaints, and the dried seeds, smoked like tobacco, have been found use-
ful in asthma. The leaves are emollient and somewhat anodyne, and
have proved beneficial in local pains, used as a cataplasm. (Grif.)

Gelsemium sempervirens, Juss. (Yellow Jessamine.) A climbing
evergreen shrub, bearing a profusion of fragrant flowers. Common
in pine woods, along streams and rivulets ; flowers in February and
March. " Possessed of narcotic properties to a very considerable de-
gree." A spirituous tincture of the root is said to have been used with
success in chronic rheumatism. It has also been employed in obstinate
intermittents. In an over dose it produces vertigo, perverted vision,
etc. (Porcher.) A fatal case of poisoning occurred two years ago in this
city, from the injudicious use of this article, in the hands of a quack.
It is worthy of investigation.

SSessamum Indicum, D. C. (Benne.) Originally introduced from
Africa by the negroes. The seeds and leaves are officinal ; the former
have a sweetish, mucilaginous taste, and abound in a bland, inodor-
ous oil, closely resembling olive oil, and capable of being kept a long
time without becoming rancid. The leaves contain a rich, gummy
matter, which they readily give out to water, forming a bland mucilage.
Two or three of the leaves stirred in a glass of water, will render it
sufficiently viscid. This is much used in bowel complaints of children.
As an application to irritable blistered surfaces, the leaves, dipped in
water, are unequalled for their soothing effect, even by the slippery
elm. The mucilage also forms an excellent application in opthalmia,
diseases of the skin, etc.

Order, Scrophulariaceae. Fig wort Family.

Verbascum thapsus, L. (Mullein.) The whole plant abounds in a
narcotic principle, most active in the flowers and root. In this as
well as botanically, it approaches Digitalis. It has been found useful
in diarrhoea and dysentery attended with tormina ; also in chronic pul-
monary affections. It should be used in decoction ; an ounce of the
leaves and flowers boiled in a pint of water, and sweetened with ho-
ney ; dose, three or four ounces. Externally, the leaves steeped in
hot water are used as an emollient anodyne.

V. blattaria, L. (Moth Mullein.) Properties similar to the last.

Scrophularia Marilandica, Ell. (Figwort.) The whole plant has a
disagreeable fetid smell, and (especially the root) a nauseous and sub-
acrid taste. It has been analyzed by Grandoni, and found to contain
a brown, bitter resin, an extractive, having the odor of benzoic acid

Dr. Hale on the Medical Botany of Louisiana.

291

with gum Inaline. It yields its properties to alcohol and water. Diu-
retic and sedative; externally, Figwort is used as a topical application
to piles, and in various cutaneous eruptions. (Griff.)

Canobea Multifida, Benth. Used as tea in the West Indies. (Raf.)
Gratiola Virginica, L. (Hedge Hyssop.) G. aurea, Muhl.; G.
acuminata, Walt.; G. pilosa, Ell.; G. sphserocarpa, G. flava, L. ; G.
Virginica, G. quadridentata, Mx. Several of these species, no doubt,
possess identical properties with the G. officinalis, and might be substitu-
ted for it.

Veronica peregrina, L. (Speedwell) Is supposed, in some parts of
the United States, to be very efficacious in scrophulous tumors of the
neck. (Grif.)

V. Virginica, L. (Tall Speedwell.") The root is bitter and nause-
ous, emetic and cathartic. It yields its active properties to boiling wa-
ter and to alcohol.

Gerardia quercifolia, Mx. Specific of the Sioux for the bite of rat-
tlesnakes. Used also for the toothache. (Raf.)

Order, Verhenaceae. Vervain Family.

Verbena hastata, L. (Purple Vervain.) Bitter, emetic, and expec-
torant.

V. urticifolia, L. A decoction of this plant, with oak bark, has been
advantageously used, in poisoning, from the poison sumach, also in ery-
sipelas.

V. officinalis, L. (Nettle leaved Vervain.) Was held sacred by
the ancients, and used by ambassadors in their treaties, sacrificial
rights, etc.

V. aubletia, L. Contains an acrid mucilage.

Callicarpa Americana, L. (Bermuda Mulberry.) A shrub bearing
red berries, in whorls around the stem, of a sweetish taste. Said to
be useful in dropsies. (Porcher.)

Order, Labiateae. (Mint Family.)

A large order with us of herbaceous plants, with quadrangular stems
and opposite branches and leaves, the latter studded with vesicles,
containing an aromatic oil. They are in all cases destitute of any poi-
sonous properties.

Lycopus Virginica, L. (Bugle Weed.) Grows in moist situations.
The whole plant is officinal. It has a peculiar but somewhat aromatic

292 The New-Orleans Medical and Surgical Journal.

odor, and a disagreeable, bitter taste, imparting these properties to
water ; narcotic, tonic and astringent. Beneficial in pulmonary affec-
tions, diminishing the frequency of the pulse, allaying irritation and
preventing cough. It acts like a mild narcotic, and at the same time
displays tonic powers. It appears to act like Digitalis, in changing
the frequency of the pulse, without the unpleasant symptoms so often
attendant on the use of that article. It may be given in infusion or in
syrup.

L. angustifolia, Ell. Var. L. sinuatus, Ell. Properties similar to
the last species,

Collinsonia ovata, Ell. Plant one foot high. In dry pine woods.
Flowers sept. The whole plant has a peculiar odor, owing to the pre-
sence of an essential oil. Carminative, tonic and diuretic.

Monarda punctata, L. (Horse Mint.) The whole plant has a strong
aromatic odor, and a warm, pungent, somewhat bitter taste. It abounds
in a powerful volatile oil, which is a good carminative, in doses of one
or two drops, on sugar ; as an external application, it is an efficient
rubefacient and counter irritant, in some cases producing vesica-
tion.

M. Mollis, Ell. Less acrid than the former species, and better suited
as a diaphoretic, when given in infusion.

Salvia officinalis, L. (Sage.) Used as a condiment ; the infusion is
used as a gargle, and also as a sudorific. It abounds in an essential oil,
containing camphor.

S. lyrata, L. (Cancer Root.) The fresh leaves of this plant, when
bruised and applied to warts, generally destroy them ; it is necessary
to continue the application several days, and renew it every 12 hours.
Ell.

S. azurea, (La Marck.) Six feet high; flowers pale blue, occasionally
white ; properties unknown.

Physostegia variegata, L. ; P. Virginica, Benth ; P. virgata, Venet;
P. denticulata, Ell.; P. intermedia, Nutt. (Dragon's Head.) Orna-
mental plants. The first named species is supposed to possess a "cata-
leptic power." (Porcher.) "Pourvues de cette singuliere faculte," namely,
" ainsi la propriete de la cataleptique, c'est-a-dire, de garder la position
dans laquelle on place la fleur." (Supplement to Die. Univ. de M.
Med. 252.)

Pycnanthemum Tullea, Leavenworth. (Mountain Mint) Several
species of Pyenanthimum are indigenous to this State. This and P*

Dr. Hale on the Medical Botany of Louisiana.

293

linifolium, Ph., are brought to market in New Orleans by the In-
dians.

Prunella vulgaris, L. (Heal-all.) Stimulant and astringent.

Scutellarea lateriflora, L. "A quack having formerly vaunted its vir-
tues as a remedy for hydrophobia, this species bears the name of Mad-
dog Scidcap.'

Trichostema dichotoma, L. T. linisare, Nutt. (Blue-curls.) Car-
minative and stimulant ; used in flatulence of infants ; an infusion of
the plant is deemed by some as almost a specific in chlorosis ; proper-
ties of the two species identical-

Teuchrium Candense, L. (Wild germander.) Aromatic, bitter and
tonic.

Heyptis radiata, L. Bitter, aromatic.

Order, Boraginaceae. Borage Family.

Rough-leaved plants, with mucrllaginous and emollient properties.

Cynoglassum Virginicum, L. (Hound's Tongue.) Root, vulnerary,
styptic; used in wounds and fluxes ; leaves narcotic like tobacco, when
smoked. (Raf.)

Batschia canescens, Ph. (Cotile Root.) Puccoon of the Indians,
who used it to paint their faces ; used to color hair oil.

Heliotropium Indicum, Ell. (Turnsole.) A coarse, unsightly
weed, used in Guinea and in India ; the juice is applied to eruptive sur-
faces and opthalmias. (Ainslie.)

Heydrolea ovata, Nutt. Grows in shallow ponds, two feet high ; a
rather handsome plant, with corymbose blue flowers.

H. quadrivalvis, Walt- Marshy places, pine woods ; a bitter princi-
ple exists in the genus. (Lindley.)

Order, Convolvulaceae. Convolvulus Family.
Convolvulus pandenatus, Ell. (Wild Potato.) Root large, milky,
and of an acid taste ; it is feebly cathartic and also diuretic, and has
been employed with supposed advantage in stranguary and calculus
complaints. (U. S. Disp.)

C. batatis, L. (Sweet Potato.) Many varieties ; has been so long
cultivated from the roots and slips, that it rarely flowers with us ; sago
has been made from it.

Cuscuta. (Love Vine.) Several species ; said to be laxative and
hydrogogue.

294 The New -Orleans Medical and Surgical Journal.

Order, Salanacea. Nightshade Family.

An extensive order, consisting mostly of herbaceous plants, with
transparent juice. The properties of this order are not uniform, though
the general character is that of acro-narcotics : but the fruits of some
species, and the roots of others, are among our most valuable esculents,
the fruits of others, again, are purely stimulant. (Grif.)

Datura Stramonium, L. (Jamestown Weed.) The effects of stra-
monium are those of an acro-narcotic poison ; heneflcially employed
in neuralgia and rheumatic pains, allaying the excessive irritability of
the system, but producing no disposition to sleep. Its most striking
beneficial effects have been witnessed in spasmodic asthma, but even
here, when smoked, (the mode of exhibition) it sometimes produces
distressing effects, and hence should be used with caution. Externally,
the extract of stramonium has been employed to dilute the pupil and
lessen the sensibility of the eye ; cataplasms of the leaves have been
found a beneficial application to inflamed and painful tumors, and to
swelled breasts of nursing women. An ointment made of the leaves
has been found to afford relief in hemorrhoids and painful ulcers.

Solanum Nigrum, L. (Nightshade.) Narcotic, diuretic and dia-
phoretic ; used in nervous and other painful affections, and in dropsy.
Externally, in the form of poultice, to pained parts, hemorrhoids, etc.
Naturalized.

S. Virginianum, Ph. Properties and uses similar to the last.

S. Carolinense, Mx. (Horse Nettle.) Valentin employed the Horse
Nettle in tetanus (non-traumatique). The juice of five or six berries
were used, augmenting the dose from day to day. (Porcher.)

S. tuberosum, L. (Irish Potato.) In addition to the value of the
Irish Potato as an esculent, the leaves and stems possess the medical
properties of the genus ; an extract of the leaves is highly spoken of
by Mr. Dyer, in chronic rheumatism, and in painful affections of the
stomach and bowels. Ph. Jour. 1,590. (Porcher.)

S. lycopersicum, L. (Tomato.) The fruit forms a wholesome arti-
cle of diet ; stated to act on the biliary organs in a very marked man-
ner. (Grif.)

S. melongena. (Egg Plant.) This furnishes another edible fruit in
general use.

Physalis viscosa, L. (Ground Cherry.) Said by Clayton to be ac-
tively diuretic. Of this genus we have six or seven species— three pe-
rennial.

Dr. Hale on the Medical Botany of Louisiana.

295

Order, Gentianacece. Gentian Family.

Sabbatia angularis, Ph. (American Centaury.) This is the most
common species of an American genus of plants, with rose colored
flowers, of great beauty, and possessed of a pure bitter principle, with
no astringency and very little aroma. It is said to act as an emmena-
gogue, when given in warm infusion, (Grif.) The other species, na-
tives of this State, are S. chloroides, Ph.; S. brachiata, Ell.; S. corym-
bosa, Bald.; S. calycosa, Ph.; S. campestris, Nutt.; S. gentianoides,
Ell. All possess similar properties.

Lisianthus glaucifolius, Nutt. A beautiful flowering plant. Proper-
ties probably similar to Sabbatia.

Gentiana saponaria, Ell. (Blue Gentian.) Grows in damp places
and along rivulets, pine woods ; readily known by its beautiful blue
flowers, expanding late in autumn, Properties similar to the European
gentian, and may be employed for the same purposes. Wood.

Spigelia Marilandica. L. (Carolina Pink-root.) A beautiful flow-
ering plant ; in shady woods. Whole plant actively anthelmintic, pur-
gative and narcotic.

Frasera Caroliniensis, Walt. (American Columbo) Frasera is an
efficacious, bitter tonic, inferior to Columbo, but fully equal to most of
the other articles of the class. Grif. Grows in Louisiana. Carpenter.

Order, Ajpocynacece. Dogbane Family.

A large order, principally tropical, composed of trees, shrubs and
herbaceous plants, abounding in a milky juice ; many of them are fine
showy plants ; the whole are suspicious, for although a few yield edible
fruits, and some an innoxious milk, the greater proportion are acrid and
poisonous. Grif.

Apocynum canabinum, L. (Indian Hemp.) The officinal portion is
the root, which pours out a milky juice, on being wounded; it is emetic,
cathartic and diaphoretic. The disease in which it has been found
most useful is dropsy ; sometimes operating as a hydrogogue cathartic,
and at others causing the most profuse discharge of urine, and thus re-
lieving the tissues of their morbid burden.

A. androsasmifolium, L. (Spreading Dogbane.) In medical proper-
ties very similar to the last.

Foresteronia difformis, D. C. A climbing shrub. The juice of this
plant is said to be sufficiently caustic to destroy warts and schirrous ex-

296

The New-Orleans Medical and Surgical Journal.

crescences ; coagulates milk, with which it is used as a wash for
freckles.

Nerium oleander. (Oleander, Laurier Rose.) Introduced. This
differs from the other plants of the order in having a transparent, and
not a milky juice, which is said to clear muddy water ; the leaves are
an active poison, and even the wood is highly deleterious. An oint-
ment made by boiling the leaves in oil or lard, is in much repute in the
South of France, in cutaneous eruptions, and to destroy vermin infest-
ing the hair or skin. Grif.

Order, Asclepiadacece. Milkweed Family.

This extensive order is composed, with us, of herbaceous, erect and
twining plants, abounding in a milky juice.

Asclepias tuberosa, L. (Butterfly-weed.) Readily distinguished by
its numerous umbells of bright orange colored flowers; the root is the
officinal part ; it is diaphoretic, expectorant, and also acts as a mild
tonic ; it has been employed in pleurisy, and other affections of the
pulmonary system, with most decided benefit, producing a copious flow
of perspiration without exciting the circulation. Dr. Eberlee found it
useful in dysentery ; it readily imparts its virtues to boiling water, and
may be used in infusion mixed with syrup or honey, or in powder ; dose
9j — 3 j. Used by Indians in snake-bite. Seven or eight other species
of asclepias are indigenous to Louisiana, most of which are probably
endowed with active medical properties.

Gonolobus Carolinianus, Ell. (Negro Vine.) The root acts on the
bowels like Colycinth. The juice serves to poison arrows in Guiana.
Raf.

G. macrophyllus, Mx. The properties are probably similar to the
last.

Order, Oleracece. Olive Family.

Chionanthus Virginica, Walt. (Fringe Tree.) A small and highly
ornamental tree, growing in dry soil. The bark is tonic and febrifuge,
with some aromatic properties. An infusion of the root is given in long
standing intermittents.

Ptelia trifoliata, Ell. (Uling Seed.) A shrub or small tree. Leaves
vulnerary, vermifuge, in tea or poultice. Raf.

Dr. Hale on the Medical Botany of Louisiana.

297

DIVISION III.

APETALOUS EXOGINOUS PLANTS.

Order, Aristolochiacea. Berthwort Family.

Asarum Virginicum, L. A. arifolium, Mx. Wild Ginger. Grow in
Louisiana, Riddelh The root, which is the part used, has an aromatic
and bitterish taste intermediate between ginger and serpentaria. The
odor, especially in the fresh state, is aromatic and grateful. It contains
an aromatic essential oil, upon which its activity depends. The root is
an aromatic, stimulant and diaphoretic, resembling serpentaria in its
action, for which it may be advantageously substituted in most cases
where that valuable article is applicable. Properties of both species
the same,

Aristolochia serpentaria, L. (Virginia Snakeroot.) The root has a
penetrating smell and bitter taste ; it acts as a stimulant tonic and dia-
phoretic, and in some cases as an anti-spasmodic and anodyne, Lindl.

A. hastata, Nutt. Grows in shady woods ; flowers in April.

A. reticulata, Nutt. Grows in pine woods ; common ; properties
similar, and equal if not superior to the officinal species.

Order, ChenopodiacecB. Goose-foot Family.
Chenopodium album, L. (Lamb's Quarter.) Leaves succulent, edi-
ble, vulnerary ; useful in gout, pleuritis, oedema, varix and fistula,
Raf.

Ambrina, anthelmentica, Spach. (Worm Seed.) This is well known
as one of our most efficient indigenous anthelmentics, adapted to the
expulsion of lumbrici in children ; it may be administered in a variety
of forms, as the expressed juice of the fresh plant, an electuary of the
seeds, either pulverized or toasted, a decoction of the leaves in milk,
and the essential oil. The latter is the best, as it contains the active
principles of the plant in the smallest compass, and is not more offensive
to the palate or stomach, than the other preparations. It may be taken
on sugar, one to ten drops three times a day, gradually increased ; it
should be followed after some days by a dose of castor oil*

A. ambrosioides, Spach. Properties somewhat similar to the above,
but less active.

Order, AmaranthacecB. Amaranth Family.
Achyranthes repens, Ell. A small prostrate plant ; grows in the
streets of New Orleans and about dwellings. A decoction of the whole

298

The New-Orleans Medical and Surgical Journal.

plant sensibly increases the urinary discharge ; in domestic practice it
is usual to give it warm, ad libitum, to patients laboring under ischary
or dysury ; the remedy is generally successful, Ell.

Order, Phytolacacce. Pookeweed Family.
Phytolacca decandra, L. (Pokeweed.) The berries, root and leaves
of the Poke are the parts used in medicine ; the berries are succulent
and contain much purple juice ; they have a sweetish but acrid taste ;
in tincture they have acquired a well-founded reputation as a remedy for
chronic and syphilitic rheumatism, and for allaying syphilitic pains,
Lindl.

The root is an exceedingly active emeto-cathartic, and in large doses
causes most of the symptoms of the acro-narcotics ; the dose in powder,
as an emetic, is 20—30 grains ; as an alterative 1 — 5 ; externally, a
drachm of the powder mixed with an ounce of lard, has been found
efficacious in psorea, tenea capitis, and some other cutaneous diseases.
The leaves are acrid, but lose this property on being boiled, and are
used as greens ; the young shoots, which are thick and succulent, and
when etiolated by being covered with rubbish, among which the plant
frequently grows, are eaten as asparagus, and by many preferred to that
vegetable, being more tender.

Rivina phytolaccoides, Nutt. A beautiful plant, with racemes
of pale purple flowers, which are succeeded by bright scarlet berries ;
of no known medical value, but should be examined.

Order, Polygonacea. Buckwheat Family.

Polygonum aviculare, L. (Knot Grass.) A mild astringent, for-
merly employed as a vulnerary and astringent.

P. hydropiper, L. P. hydropiperoides, Mx. (Water Pepper.) The
leaves of these plants have a burning and biting taste, and even vesicate
when applied to the skin, and produce the same effect on the horse,
completely removing the hair from the part on which it is rubbed : em-
ployed in veterinary practice as a revulsive ; occasionally used as a
detergent in chronic ulcers, and internally in gravel. Doctor Eberlee
strongly recommended it in amenorrhea, in which complaint he found
no other remedy equally effectual. Dose, one drachm of the saturated
tincture, or 4 — 6 grains of the extract, three times a day. U. States
Disp.

P. amphibium, L. The root has been employed as a substitute for
sarsaparilla,

Dr. Hale on the Medical Botany of Louisiana.

299

Rumex crispus, L. (Dock.) Root astringent and tonic, said to re-
semble rhubarb in its operation ; employed externally in various cuta-
neous affections. The leaves of several species of dock are used as
greens.

Order, Lauracem. Laurel or Bay Family.

Laurus sassafras, L. (Sassafras.) A large shrub, occasionally be-
coming a tree seventy feet in height and two in diameter ; most parts of
the tree, but especially the bark of the root, abound in an essential oil,
of a yellow color, heavier than water; the bark is stimulant and dia-
phoretic, and is used, in combination with other articles, as guaicum,
sarsaparilla, etc., in cutaneous, rheumatic and venereal complaints; the
leaves and pith afford an abundance of mucilage, of a peculiar charac-
ter, not being affected by alcohol ; used as an application to inflamed
eyes ; they form an excellent diluent drink in affections of the bowels
and bladder ; as a culinary article, the leaves, finely powdered, are
employed in making gumbo.

L. Carolinensis, Mx. (Sweet Bay Laurier.) A small tree or shrub,
growing in damp places, pine woods ; bark and leaves acrid and
aromatic ; the latter and the buds mucilaginous, stomachic, carminative
and emmenagogue ; leaves used in cookery.

L. mellissaefolia, Walt. Grows around pounds, etc. A shrub, pos-
sessing similar properties to the last.

L. Benzoin, Walt. (Spice -bush.) An aromatic shrub, flowering in
February, before the expansion of the leaves, and ripening its scarlet
berries in September ; these last are aromatic and contain much oil ;
the bark is also aromatic, tonic and stimulant, and has been employed
with much success in the treatment of intermittent fevers ; it has usu-
ally been administered in decoction, but sometimes in powder, Grif.

Order, Loranthacece. Mistletoe Family.
Viscum verticillatum, Ell. At one time the mistletoe was highly
esteemed as a remedy for apoplexy, palsy and other nervous diseases,
but is now out of use ; the white viscid berries are used in making
bird-lime.

Order, Ulmacece. Elm Family.

Ulmus fulva, Mx. (Slippery Elm.) Elm bark has a peculiar odor
and not unpleasant taste ; children are fond of it in its fresh state, and
it forms a good article of diet when nourishment of the blandest kind is
required ; it abounds in mucilage ; the bark of old trees is to be pre-

300

The New-Orleans Medical and Surgical Journal,

ferred, being thicker, less fibrous, and more brittle than that of the
young trees ; the complaint that the former description (U. S. Disp.)
is inferior, must be owing to its having been damaged, or possibly to
some other bark being mixed with it. Slippery Elm bark is emollient
and demulcent, applicable to all cases where medicines of this class
are employed; it is especially reeommended in dysentery, diarrhoea and
diseases of the urinary passages, Wood, The dry, inner bark, from
its expansive property, has been formed into tents and bougies for di-
lating sinususes and morbid contractions of the urethra. By glueing
thick pieces of the bark together, tents or bougies of any desirable
size are formed. Externally, the bark forms an invaluable emollient
application to inflamed and irritable surfaces ; it may be applied in the
form of poultice.

The following species of Elms also abound in this State : U* Ameri-
cana, L. U. racemosa, Thomas. These are large trees. U. atala,
Mx., (Wahoo) a small tree ; U. crassifolia, Nutt, a tree rather below
the middle size, flowering in September, The bark of all these is as-
tringent and tonic, but not at all mucillaginous.

Cettis occidentalis, Mx. (Hackberry.) Bark anodyne, cooling ;
berries, sweet, astringent, good to eat, useful in dysentery, Raf.

C. pumila, Ph. Properties similar to the above.

Order, Saururacece. Lizard's -tail Family.
Flowers fragrant, roots emollient, discutent; used in poultice, roasted
and mashed, by the Cherokees, Raf.

Order, Euphorbiacece. Spurge Family.

Trees, shrubs and herbs with milky juice ; their original character
is acridity, in some to such a degree of concentration, as to be poison-
ous, while in others it is merely sufficient to render them emetic, cathar-
tic, etc. ; and in some again it is so diminished, that their juice is mild
and nutritive, Grif.

Euphorbia corollata, L. (Wild Ipecac.) A very common and well
known plant, growing in dry soil ; the root, which is the officinal part,
is inodorous and almost tasteless. According to Dr. ZollickofFer, who
first introduced it to the profession, it contains resin, caoutchouc, gum,
and probably starch. It is a certain and active emetic, but like most
articles of its tribe, is liable to act on the bowels, and in over doses with
extreme violence ; in very small doses it acts as a diaphoretic. Dose
as an emetic, 15—20 grains ; as a diaphoretic, 2—3, The recent

Dr. Hale on the Medical Botany of Louisiana.

801

root, bruised and applied to the skin for a few minutes, will create a
pustular eruption.

E. hypericifolia, L. (Black Purslane.) Astringent and narcotic;
beneficial in dysentery, also in menorrhagia and fluor-albus. Dose, a
wine glass of the infusion, one ounce of the dried plant to a pint of boil-
ing water, several times a day.

E. thymifolia, L. In India the powder is administered in the vermi-
nose diseases of infants. Ainslie.

Acalypha Virginica, L. This plant is said by Dr. Aikin to be ex-
pectorant and diuretic ; he has used it successfully in cases of humid
asthma, ascites and anasarca. Ell.

Stillingia sylvatica, L. (Queen's Delight.) Grows abundantly in
dry pine woods ; used to some extent in South Carolina in scrofula and
cutaneous diseases, Porcher. From observations of Dr. Lopez, of Mo-
bile, it appears to be one of our most valuable indigenous alteratives ;
he employed it in combination with sarsaparilla, in secondary and ter-
tiary syphilis, typhoid fever, chronic rheumatism, etc., with eminent suc-
cess. (N. O. Med. and Surg. Jour. vol. 3, p. 40.) Used by the Ca-
manche Indians in chronic diarrhoea. This practice has been followed
by an intelligent planter of this State, on his plantation, for many years,
with satisfactory results.

S. ligustrina, Mx. A handsome shrub, worthy of investigation.

S. Sebifera, L. (Tallow Tree.) Introduced from China ; cultiva-
ted in and around New Orleans as an ornamental shade tree ; it bears
a profusion of flowers, which, on a large majority of trees, are all ster-
ile, and when they are fertile, many of them fall off without producing
fruit. The infertility is probably owing to the tree having been culti-
vated from branches instead of seed. The Chinese, according to
Thunberg, employ the concreted oil extracted from the fruit, in the ma-
nufacture of candles ; an ointment made from the oil is employed in
nocturnal fevers* Porcher.

Ricinas communis, L. (Palma Christi.) A native of China ; in
gardens and neglected places ; grows well and bears abundantly.

Order, Juglandacea. Walnut Family.

Juglans nigra, L. (Black Walnut.) Grows in fertile hills; inner
bark acrid and styptic ; dyes black ; the fresh rind of the fruit cures
ringworms, tetters, etc. Nuts edible, yield oil ; immature fruit used
for pickles and making catsup.

302 The New-Orleans Medical and Surgical Journal.

Carya olivseformis. (Pecan.) A large forest tree, esteemed for its
edible nuts. Several other species of carya yield edible nuts ; bark of
all the species astringent ; tinctoreal ; used for dying woollens on plan-
tations.

Order, Cupuliferece. Oak Family.

Quucus tinctoria. (Black Oak.) Of the oaks, we have in Louisi-
ana about twenty species, all trees, generally large ; they are of greater
use in the industrial arts than as medical agents ; their general char-
acter is that of astringents ; they all possess similar properties, varying
in degree, principally.

The bark, which is the officinal part, has an austere, bitterish taste,
and contains tannin, gallic acid and an extractive matter. It is astrin-
gent and somewhat tonic, and has been used with advantage in inter-
mittent fever, chronic diarrhoea, and in certain forms of passive hemorr-
hage ; externally applied it is often productive of benefit : the decoction
may be advantageously used as a bath, particularly for children, where
a combined tonic and astringent effect is desirable, and the stomach is
not disposed to receive medicines kindly. It has been employed in
marasmas, scrofula, intermittent fevers, chronic diarrhoea and cholera
infantum ; as an injection in leuchorrcea ; a wash in prolapsus ani and
htemorrhoidal affections ; and a gargle in slight inflammation of the
fauces, attended with prolapsed uvala ; the decoction is often highly
useful. U. S. Disp.

Castanea vesca, L. (Chestnut.) In Louisiana, Riddell, chestnut;
a large tree, not found in the western part of this State.

C. pumila, Mx. (Chinquepin.) A shrub or small tree, frequently
attaining a height of 39 — 40 feet, with a diameter of 15 — 20 inches.

C. alnifolia, Nutt. (Dwarf Cinq.) A small shrub, with creeping
roots, growing in patches, pine woods.

The fruit of all these species is sweet and edible ; the bark is astrin-
gent and tonic, and has been employed in the cure of intermittents.

Fagus feruginea, Ait. (Beech.) The bark of the beech is astrin-
gent, and has been used in the treatment of intermittents. A narcotic
principle called fagine has been found in the husks. The nuts are
edible ; they afford an oil little inferior to olive oil. The lard of hogs
fattened on beech nuts is oily, and the flesh soft and of an inferior qual-
ity.

Order, Myricacece. Sweetgale Family.
Myrica cerifera, L. (Wax Myrtle.) A very common evergreen

Dr. Hale on the Medical Botany of Louisiana. 303

shrub ; the bark of the root is acrid, stimulant and astringent. The
decoction is employed as a domestic remedy in chronic diarrhoea of chil-
dren. The berries afford a large amount of wax, of a peculiar green
color. It is procured by boiling the berries, when it rises to the sur-
face of the water ; it appears to possess astringent and narcotic pro-
perties, and has been successfully employed in typhoid dysentery. (Am.
Jour. Med. Scien. III. 313.)

M. Caroliniana, Wrang. A small shrub, with larger leaves than the
last; properties similar.

Order \ Betulacea.

Betula nigra, L. (Black Birch.) The bark has a sweet spicy smell
and taste; diaphoretic ; the empyrumatic oil of the distilled wood gives
the peculiar smell to Russia leather. Raf.

Alnus serrulata, Ait. (Alder.) The bark and leaves are bitter and
somewhat astringent ; used in scrofula and cutaneous diseases ; also in
hematuria ; the bark is used by tanners and dyers.

Order, Salicacea. Willow Family.
Salix nigra, Ell. (Black Willow.) A small tree, very common on
river banks, etc.

S. longifolia, Muhl. (Long-leaved Willow.) Smaller than the last,
tall and slender, flowering after the expansion of the leaves.

S. Conifera, Wrang. (Cone-leaving Willow.) A small shrub,
grows on moist upland and prairies.

These species possess analogous properties ; the bark has a bitter,
astringent taste, and when dry, a slight aromatic odor. It has been
long employed as a substitute for the Peruvian bark in the cure of inter-
mittent fevers, but is comsidered inferior to that article. Salicin pos-
sesses tonic properties analogous to quinia, but in an inferior degree ;
as a simple bitter it appears to rank with gentian, Colombo, etc. ; its
principal good effects being seen in the improved appetite that frequently
follows its use.

Populus angulata, Ait. (Cottonwood.) One of our largest forest
trees; common in alluvial soil; the bark possesses properties analogous
to that of the willow ; it contains salicin, and another chrystalizable
principle called populin. The leaf buds exude a resinous substance of
a balsamic odor and bitterish, pungent taste. It has been employed in
the form of spirituous tincture in pectoral, nephritic and rheumatic com-
plaints.

304 The New-Orleans Medical and Surgical Journal,

Order, Balsamijluce. Sweet Gum Family.
Liquidamber styraciflua, L. (Sweet Gum.) This tree exudes a fra-
grant, balsamic resin, in this climate, in considerable quantities; sought
after by children, who are fond of chewing it. Properties those of the
other balsams, Grif.

Order, Urticacea. Nettle Family.
Morus rubra, L. [Red Mulberry.] A small tree, grows in fertile
soil. Mulberries are refreshing and laxative, and serve to prepare a
grateful drink well adapted to febrile cases ; a syrup is made from the
juice, and used as a pleasant addition to gargles, in inflammation of
the throat ; they are, however, more used as food than medicines. U.
S. Disp.

Maclura aurantia, Nutt. [Osage Apple.] A tree 30 feet high, wood
compact, saffron colored ; grows on Red River. Properties unknown,
but probably deserving enquiry.

Urtica Canadensis, L. [Canada Nettle.] Stinging, bark fibrous ;
has been spun as flax.

U. purpurascens, Nutt. [Purple Nettle.] Nearly allied to U, dioica^
and possessing similar properties ; haemostatic.

Pilea pumila, Gray. [Rich Weed.] The smooth stems pellucid ;
said to be useful in the form of poultice, to inflamed surfaces, and to
relieve the eruption caused by the poison sumach.

SUB-CLASS GYMNOS PUJLB.

Order, Coniferce. Pine Family.

Pinus australis, Mx. [Long-leaved Pine.] A large tree, forming
vast forest, to the exclusion of almost every other growth. This species
furnishes the greatest proportion of turpentine obtained in the Southern
States.

P. tseda, Willd. [Loblolly Pine, Old-field Pine.] This is a much
larger tree than the preceding, frequently growing in moderately fertile
soil, overtopping the surrounding forest trees; yields turpentine in mod-
erate quantity and consistent quality.

P. mitis, Mx. [Yellow Pine.] Like all the genus, yields turpen-
tine.

Cupressus disticha, L. [Cypress.] A rich balsam is obtained from

Dr. Hale on the Medical Botany of Louisiana.

305

incisions in the tree and from the cones, by boiling ; it is diuretic and
carminative ; externally it is applied to cuts and wounds.

Junipems Virginiana, L. [Red Cedar.] Grows abundantly and to
a middle sized tree, on the alluvial lands of Red River, near the State
line. The leaves only are officinal ; they have a peculiar, not unplea-
sant odor, and bitter taste, stimulant, diaphoretic, diuretic and emmena-
gogue.

CLASS II.

3Ionopetalous or Endoginoas Plants.

Arum draconitum, L. [Indian Turnip.] A Triphillum, L. These
species possess identical properties ; the corm or root in the recent
state has a peculiar odor, and is virulently acrid, producing a burning
sensation when applied to the tongue ; the partially dried root has been
advantageously given in asthma, chronic catarrh, chronic rheumatism,
and various affections connected with a cachectic state of the system.
It may be given in doses of ten grains, in sugar or gum arabic, repeated
several times a day; the roots may be preserved fresh in sand for me-
dical use for a long time ; the turnip yields starch of a superior
quality.

Peltandria Virginica, Raf. [Virginia Indian Turnip.] Properties
similar to the preceding ; grows in marshes.

Acorus Calamus, L. [Calamus Sweet Flag.] The root, the part
used, has a strong and fragrant odor, and warm, bitterish, aromatic
taste ; it yields its virtues to water, but more fully to alcohol. It is
stimulant and tonic; useful in colic and atonic conditions of the stomach,
and other deranged conditions of the gastric organs ; it may be given
in powder ; dose, 9 j, or in infusion; when prescribed in flatulent colic
of children, it should be combined with magnesia, Grif.

Order, Typhacece, Cat-tail Family.
Typha latifolia, L. [Cat- tail.] The powdered flowers have been
used as an application to ulcers. The pollen of typha is inflammable,
like that of lycopodium, and is used as a substitute for it, Lindl.

Order, AHsmacece. Water Plaintein Family.

Aquatic or semi-aquatic plants, with fleshy roots, which are whole,
some and nutritious.

306 The New-Orleans Medical and Surgical Journal.

Sagittaria sagittifolia, Mx. [Arrow-head.] Several varieties ; the
root is much employed as food among the aboriginal tribes. The
leaves applied to the breasts of nursing females, it is said, will tend to
dispel the milk, Grif.

Several other species of arrow-head grow in this State, all probably
possessing similar properties.

Order, Orchidaceai. Orchis Family.

This is an extensive order, with us, of perennial herbs, more remark-
able for the bizarre figure of their multiform flowers, which are some-
times of surpassing beauty, than for their value as remedial agents; the
nutritive substance salep, is supposed to be derived from some species
of orchis ; and it is probable that all the species of this and the allied
genera will afford this article.

Cypripedium pubescens, Ell. [Ladies Slipper.] The root, which
is the officinal part, is mucilaginous, and has a pungent, nauseous taste;
sedative and antispasmodic ; employed as a domestic remedy in numer-
ous affections of the nervous system. Dr. Ives has used it in hypo-
chondriacal cases and certain neuralgic affections, with morbid sensibil-
ity of the whole nervous system, obtaining from a dose of twelve grains
sound and perfect sleep, when all the usual preparations had failed.
Our other native species of cypripedium, C. specabile, Willd, and C.
parviflorum Salisb, Riddell, are supposed to be identical in properties
with the preceding.

Goodyera pubescens, R. Br. [Neottia, Ph.] [Cancer Weed.] G. gra-
cilis, Beyll. G. latifolia, Torr. G. cernua, Ricord. G. aestivalis.
Sensible and medicinal properties very similar to cypripedium. The
recent plant and roots bruised are applied in cancer, lupus and other
ill-conditioned ulcers ; the root is given internally in the form of pow-
der, in nervous and convulsive diseases; it quiets irritation of the ner-
vous system and produces sleep.

Order, Amaryllidacea. Amaryllis Family.

Amaryllis atomasco, L. [Atomasco Lilly.] A beautiful vernal plant,
said to poison horses and cattle, producing the disease called stag-
gers.

Pancratium coronarium, Le Conte. Grows in marshes, flowers in
April.

P, occidental, Le Conte. Grows in dry soil; flowers in August;

Dr. Hale on the Medical Botany of Louisiana. 307

handsome flowering plants, with large bulbous roots. Fresh roots eme-
tic ; acts like squills, but weaker ; diuretic, Raf.

Hypoxis erecta, L. [Star Grass.] Root tuberose, edible, eaten by
children, sought after by hogs, which become fat by feeding upon them.
Vulnerary, febrifuge, used in agues and in chronic ulcers. Raf.

Order, Haidomoracece. Bloodwort Family,

Aletris farinosa, L. [Blazing Star.] Root intensely bitter ; tonic
and stomachic, and in large doses emetic and cathartic, displaying nar-
cotic properties. Employed with benefit in colic, in chronic rheuma-
tism, and in dropsical affections ; a spirituous tincture is the best form
of administration.

A. aurea, Walt. Flowers yellow ; expand later than in the preced-
ing species ; properties no doubt similar.

Order IridacecR. Iris Family.

Iris versicola, L. I. hexagona, Walt. I. cuprea, Ph. I. cristata,
Mx. [Flower-de-Luce.] All more remarkable for the beauty of their
flowers than for their utility. The recent root has an unpleasant acrid
taste, which is diminished by age ; it is emetic, cathartic and diuretic.
It was a favorite remedy amoug the Indians, and used by them in most
cases requiring purgation, Grif.

Sisyrinchium anceps, S. Bermudianum, S. mucronatum, Mx. S.
minus, Gr. and Eng. [Blue-eyed Grass.] The roots of all our native
species are acrid, and in decoction are said to be purgative, Grif.

Order Dioscorea. Yam Family.

Dioscorea villosa, L. [Wild Yam.] A decoction of the root is un-
questionably a valuable remedy in bilious colic ; an ounce of the root
is to be boiled in a pint of water, and half of it given at once. It acts
with remarkable promptitude ; diaphoretic, expectorant and emetic.
Riddell.

Order, Smilacea. Smilax Family.

Herbaceous plants and under shrubs, sometimes climbing and often
having fleshy tubers.

Smilax herbace, L. Properties unknown.

S. glauca, Walt. S. sarsaparilla, L. Grows in moist woods, very
common ; root large and tuberous. Spoken of by Martens [Travels, I,

308

The New-Orleans Medical and Surgical Journal.

96] as being highly prized in Brazil as a specific in syphilis, and also
beneficial in gout and chronic cutaneous complaints.

S. pseudo-China, L. Grows in Louisiana, Riddell. Used in medi-
cine as an alterative, and as well as the preceding species, forms the
basis of many diet drinks. From these roots, with sassafras, Indian
corn and molasses, the negroes manufacture a very agreeable beer,
Ell.

S. laurifolia, L. Stem large, prickly below ; climbing small trees,
and covering them with its rich evergreen foliage. Root tuberous,
large; enters into the composition of diet drinks, sarsaparilla compounds,
etc. Used as food by the aborigines, and the practice has been made
available by their European successors in time of scarcity. Flowers
in August, and matures its fruit in winter. Grows about springs, and
in places perennially moist.

S. lanceolata, Walt. In deep marshes ; berries red ; they abound
in a substance resembling caoutchouc, capable of great distension;
blown into balloons by children.

S. pumila, Walt. Prostrate, berries scarlet ; in dry soil.

Some half dozen other species of smilax are common in this State,
most of which possess similar properties to the foregoing.

Trillium sessile, L. [Three-leaved Nightshade.] The only species
found in this State. To the North they are numerous ; they all possess
the same properties. The tuberous roots have a faint terebinthenate
odor, and a peculiar aromatic taste, producing, when chewed, a sensa-
tion of heat about the fauces and an increased flow of saliva. They
were in use among the Indians in hemorrhagic discharges, particularly
in those peculiar to females, Grif.

In domestic practice they are administered preparatory to parturition,
hence the name, Birthroot, Riddell. The roots are generally violently
emetic, and their mawkish, rather nauseous berries, are at least suspi-
cious, Lindl.

Order, Liliaceaz. Lilly Family.

Asparagus officinalis. [Garden Asparagus.] A native of Europe,
escaped from gardens, and partially naturalized in this country ; diure-
tic. U.S. Disp.

Polygonatum pubescens, Ph. [Smaller Solomon's Seal.] Properties

Dr. Hale on the Medical Botany of Louisiana.

309

similar to Convallaria Polygonatum, Lam. Vide United States Disp.
1320.

Scilla angustata, Eng. and Gr. [Quamash,] [Beargrass.] Probably
only a variety of S. esculenta. Natchitoches and above.

S. crocea ; dry soil ; a much smaller plant than the preceding. V.
Pursh. Flor. Am. Sept. 1, 226.

Order, Melanlhacece. Colchicum Family.

Melanthium Virginicum, L. Grows in wet, shady situations. Like
most of the order, this is an active poison ; a certain but rather dan-
gerous remedy for the itch ; used as a wash. U. S. Disp.

Stenanthium angustifolium, Gray.

Veratrum, Pursh.

Grows in open pine woods ; root bulbous ; stem 4 — 6 feet high?
slender; panicle of white flowers, often two feet long. Medical proper-
ties probably similar to those of V. viride. [See N. O. Medical and
Surgical Journal, for September, 1852, p. 141.] Worthy of investiga-
tion.

Order, Commelynacece. Spiderwort Family.

Commelyna Virginica, L.

C. erecta ; C. communis. [Day Flower.]

Properties identical ; root antifebrile ; leaves eaten by the Indians as
greens, emollient, pectoral and anodyne; the blossoms afford a fine
azure blue, by a peculiar process, called Hoosack, in Japan, Raf.

Tradescantia Virginica, L.

T. pilosa, Lehm.

T. rosea, Went. [Spiderwort.]

Ornamental, leaves much liked as greens by the Cherokees, Raf.

Order, Cyperacece. Sedge Family.
Grass like plants, with solid, triangular stems.

Cypecus repens, L. [Nut-grass, Sweet Coco.] Grows in fertile,
sandy soil ; tubers sweet, edible, sought after by hogs.

C. hydra, Mx. [Coco Grass, Bitter Coco.] This scourge of the
Southern planter has gradually spread until it has reached the Northern
boundary of the State, at a few points. It was probably introduced
from the West Indies, where it is said by Dr. Hamilton to be a pest to

310

The New -Orleans Medical and Surgical Journal,

to the sugar plantations, overrunning them and rendering them barren.
The roots are bitter, and slightly astringent ; eaten by hogs.

Cyperus articulatus, Mx. Grows in Louisiana, Carpenter. In Gui-
nea this is considered one of their remedies for worms, Mer, and De
Lens.

Eliocharis palustris, R. Br. [Bog Scirpus.] Lemay says the roots
are astringent, and that they are employed in decoction in diarrhoea and
hemorrhage. Mer. and De Lens. Porcher.

Order Graminece. Grass Family.
Stems cylindrical, hollow, closed at the joints.

Ozyra saliva. [Rice.] A genus supposed to consist of but a single
species. The varieties are almost innumerable, some of which differ
widely from each other — "Being wholly free from laxative properties, it
is adapted to cases of lax bowels, in which there is a tendency to
diarrhoea." The opinion that a rice diet produces injurious effects on
the eyes, is maintained by Dr. Porcher, whose opportunities of obser-
vation appear to have been ample. Doctor Dickson, on the contrary,
dissents from it entirely. Rice is still cultivated to some extent in this
State, but less than formerly.

Zea maize. [Indian Corn.] This useful genus, native of America,
like the preceding, comprises but a single species, but the varieties are
exceedingly numerous. Corn differs from the other ceralia in contain-
ing no gluten ; hence the meal does not undergo the fermentation called
rising, Grif.

Cynodon dactylon, Pers. [Bermuda Grass.] Introduced, common;
the root is used in the shape of ptisan, as an apperient and diuretic;
the extract is said to purge, like manna ; the plant contains a nutritive
principle. Dem. Elem. de Bot., quoted by Porcher.

Glyceria fliutans, R. Br. [Manna Grass.]

Saccharum officinarum, L. [Sugar Cane.] Probably a native of
Southern Asia. Many varieties cultivated. Sugar is but little em-
ployed in medicine, but enters largely into the composition of many
compound remedies. Dr. Rush says that sugar and molasses, when
freely used by children, are excellent anthelmintics; sugar has likewise
proved beneficial in scurvy, and in some chronic diseases of the skin;
it has been recommended as an antidote in poisoning by arsenic and
several other mineral salts, but as its action is merely that of an emol-

Dr. Hale on the Medical Botany of Louisiana. 311

lient and demulcent, it should not be relied on to the exclusion of other
remedies, Grif.

Zizania aquatica, L. [Wild Rice.] Grows in marshes, frequently
in water, six to twelve feet high ; ripens its fruit in October. The
grain is a favorite food among the Northern Indians.

SERIES II.

Cryptogamous or Flowerless Plants.
Vegetables destitute of proper flowers.

CLASS III. ACROGENS.

Order, Equisetacew. Horse-tail Family.

Equiesetum hyemale, L. [Shave Rush.] Formerly grew in dense
brakes of great extent, on the alluvial land of the Mississippi and Red
River, six feet high ; roots stimulant and diuretic ; used in dropsies,
meastural and syphilitic diseases, Raf. Produces purgation in horses ;
useful for polishing wood and metal; a property which is due to the
great quantity of silex deposited beneath the cuticle.

Order, Felices. Ferns.

Leafy plants, with the leaves generally rising from prostrate root-
stalks, rolled up in the bud.

The leaves generally contain a thick astringent mucilage, with a lit-
tle odor, on which account many are considered pectoral and laxative.
The stems are both bitter and astringent, hence have been employed
as anthelmintics ; they are emmenagogue and purgative.

PolypodiaecB. True Ferns.

Polypodium incanum, Willd. Grows on the inclined trunks of
trees. Properties probably similar to P. vulgaris. Vide Grif. Med.
Bot. 070.

P. hexagonopterum, Mx. Shady woods.

Pteris aquilina, L. [Common Brake.] Root [stem] astringent and
vermifuge ; said to be a remedy for tape worm, an ounce of the infusion
being given at a dose. This plant yields a large proportion of alkali,

312 The New Orleans Medical and Surgical Journal.

and on the burning of the pine woods, where it grows abundantly, re-
turns to the soil a fertilizing principle in which the pine is deficient; the
astringent principle renders it useful in the preparation of leather and
kid gloves, Porcher.

Osmunda spectabilis, Willd. [Flowering Fern.] Root demulcent,
sub-astringent, esculent, boiled in milk like arrow-root ; useful in diarr-
hoea, cholera infantum, etc., Raf.

O. cinnamomea, L. [Common Fern.] Vermifuge ; eaten by In-
dians, Raf.

Botrichium Virginicum, Swatz; lunairoides, Swatz. [Manwort.]
Mild astringents.

Ophioglossum vulgatum, L.

O. bulbosum, Ell. [Snake Leaf.] Emollient ; used for ulcers and
sores, Raf.

Lycopodium alopecuroides, L. [Clab-Mass.]
L. clavatum, L.

L. Corallinianum, Rid. Diuretic, emmenagogue and aperient. Used
in dropsy, gout, scurvy and diarrhoea. Inflammable pollen used in
pyrotechnics, Raf.

ADDENDA.

Scutellaria lateriflora. [Sculcap.] Dr. Cleaveland of Vermont re-
commends the sculcap as a valuable nervine, allaying nervous irritabil-
ity from whatever cause produced. In delirium tremens, tic-doulour-
eux, convulsions from irritation of the ganglionic nerves or spinal cord,
in chorea sanctiviti, dental irritation among children, as well as in the
ordinary diseases of the nerves, when a soothing and quieting medicine
is indicated, Dr. C. prefers it to all other antispasmodics, except where
a more immediate impression is desirable, when he would have recourse
to ether, chloroform, etc. He considers it a tonic, diaphoretic, and diu-
retic.

Dr. Stabler of Virginia adds his testimony to the efficacy of the
sculcap in tic-douloureux, tremors from alcoholic drink, and depression
of spirits from dyspepsia. Dr. C. has no experience of the remedy
in hydrocephalia, but is disposed to believe it may deserve some por-
tion of the reputation it once enjoyed in that formidable disease. Dose,
B j infused in a pint of water, and a wine-glass to be taken three or
four times a day.

Isnardia palustris, L. [Water Purslane.] A small creeping or
floating plant, on the margins of ponds and ditches. Used for asthma

Dr. Hale on the Medical Botany of Louisiana.

313

and chronic cough, phthisis,etc ; also in catarrhal fever. An infusion,
f j to a pint of water, and drank during the day, will often relieve the
paroxysm of asthma, after the most powerful narcotics have failed.
Ives.

Isnardia natans, T. and Gr. A larger plant than the preceding, with
longer capsules, and perfectly formed petals, frequently submersed.
Properties, no doubt, very similar.

Bumeliacece. [Pine Apple Family.]

Agave Virginica. [Virginia Aloe.] Plant four feet high, flowers
fragrant, root bitter. Tincture used for cholic. Chewed in obstinate
diarrhoea by the Cherokees. Violent, but efficient, Raf.

A. Americana, L. [American Aloe, Maguey.] A large evergreen,
succulent plant, indigenous in Mexico and other parts of tropical Ame-
rica.

The supposition that the agave flowers but once in a century is erro-
neous ; this happens every fifteen or twenty years, a long period being
required for the offshoots to attain sufficient maturity to bear flowers
and fruit.

On being tapped it yields a large amount of saccharine juice, which,
by evaporation, may be converted into syrup, and even sugar. By fer-
mentation it is changed into the vinous liquor called Pulque, from which
a spirit, known under the name of Vino Muscal, is obtained. The
juice, when fresh, has an acrid taste, and reddens litmus paper. It is
said to be laxative, diuretic and emmenagogue. The fibres of the old
leaves, separated by bruising and maceration in water, are used for
forming thread, [Lenoble] which is woven into coarse fabrics suitable
for common wear. Cordage, likewise, of a durable character, is manu-
factured from it.

314

The New-Orleans Medical and Surgical Journal.

JI. — CASE OF SPINA BIFIDA— IMPERFORATE ANUS— RETEN-
TION OF PLACENTA FROM MORBID ADHESION — DISEASE OF
THE FUNIS, &c— RECOVERY.

BY W. TAYLOR, M. D., ALA.

The following cases, from the number of abnormal conditions which
they comprise, are sufficiently interesting to be placed on record.
They were in the person of a young married woman, and a fcetus,
which recently fell under my observation, some of the particulars of
which are as follows ;

Was called on the 13th of July last to see Mrs. , a woman of ro-
bust constitution, sanguinio-bilious temperament, aged about 20, whom
I found in the second stage of labor, in the eighth month of her first
pregnancy. On making a digital examination, I found the os uteri con-
siderably dilated with a foot presentation ; but regarding the maxim,
that a " meddlesome midwifery is bad," I did not attempt to turn the
fcetus, but left the labor to its natural course. It progressed smoothly and
rapidly, and in about three hours after making the first examination,
the membranes were ruptured, and a living foetus quickly expelled.

MONSTROSITY.

The fcetus presented a most rare and singular case of malformation.
The spinous processes of the four lower lumbar vertebrae were entirely
wanting. In the situation of the mal-formed bones was a soft, fluctuat-
ing humor, filled with a light chocolate colored fluid. The fluid forming
the tumor was contained within the membranes, or sheath of the spinal
marrow, and was not covered by the common integument.

The concave surface of the os coccygis looked posteriorly, the infe-
rior extremity of which formed a projecting, bony tumor, somewhat
after the manner of a rabbit's tail, which gave it a most singular and
grotesque appearance.

The anus was imperforate, and drops of meconium were constantly
oozing from the urethra, making it plainly evident that the bowel had
terminated in the bladder.*

The scrotum was bifurcated, and formed two folds, resembling the
labia pudenda of the female. In these folds were lodged the testes,
which were of common fcetal size.

* Dr. H. McKenzie, an eminent practitioner of this place, has met with two

cases of imperforate anus, in which the rectum terminated in the bladder.

Dr. Taylor on a case of Spina Bifida.

315

The penis was without a prepuce, and in general conformation closely
resembled the clitoris of the female. The only conditions which made it
dissimilar to the clitoris were its enlarged size, and the passage of the
urethra through it. The urethra was highly inflamed, from irritation
set up by the meconium, which, as stated above, escaped from it.

The right foot was almost of a jet black color ; the skin gradually
becoming lighter as it ascended the leg, until it reached the knee, when
it again assumed its natural hue. The great toe on this foot had three
phalangeal bones, and greatly distorted from its natural form. The
whole length of the foetus was about fifteen inches. I regret that I
could not obtain the permission of the parents to bear it off, for a more
minute and thorough inspection — it having died about half an hour
after birth.

Funis. The cord was much diseased, and so very fragile that it
would not bear the traction of more than a few ounces. Its diameter
was almost triple as great as it should have been — the increased size
being produced by the too abundant deposition of gelatin in its cells.

Placenta. — After waiting the usual time for the expulsion of the pla-
centa, there being no uterine pains, I endeavored to excite them by
grasping the womb through the abdominal parieties, but could effect
nothing practical by it. Failing by this means to excite the uterus to
contraction, 1 administered a dose of Ergot, which produced several
severe pains, but the mass was yet unmoved. On introducing my
hand into the cavity of the uterus, I found that the placenta was retained
by morbid adhesion. A segment of about one third of its surface was
detached, while the other two thirds was firmly agglutinated.

Insinuating my fingers cautiously under the detached portion, with
my knuckles towards the uterine surface, and the palma face looking
to the placenta, I endeavored, by a gentle sawing motion of the fingers,
to continue the separation, but found the agglutination so firm and un-
yielding that it could not be done. I next expanded my fingers over
the foetal surface, and tried the effect of squeezing the edges towards
the centre ; but all that I could do in this way was to break the pla-
centa.

Finding separation impossible, I brought away the detached portion,
and left the remainder to time and the vis medicatrix natural.

She had considerable hemorrhage, which all ceased with my mani-
pulations. Giving her an anodyne, which immediately composed her,
and remaining with her two hours longer, to see that no hemorrhage
occurred, I left her, to visit her again on the morning of

316 TIw New-Orleans Medical and Surgical Journal.

July l&th. Find her more composed this morning than I expected.
Skin moist and cool ; tongue very slightly furred ; slight pain in the
back, and some soreness in the uterine region ; pulse 122 beats per
minute ; free discharge from the bowels. Ordered a saline purge,
with warm teas through the day.

July 15th. Hot skin, and excrutiating pain in the back, radiating
thence through the abdomen and thorax. Tongue white and dry; pulse
wiry and 140 beats per minute ; great nervous disturbance, and con-
stant twitching of the muscles, and an intolerable tenderness of the
abdominal viscera. Prescribed a drachm dose of Laudanum immedi-
ately, which was repeated at the expiration of 30 minutes. At the end of
40 minutes these formidable symptoms had all measurably disappeared;
the skin becoming soft, the tongue moist, the nervous system composed,
the pulse comparatively soft, and falling down to 120 pulsations per
minute ; and in one hour and a half the patient was sleeping. Left
her the following :

3^ Calomel, grs. iii

Opii Pulv. gr. i

To be given at intervals of four hours, until four portions are taken.

Several fragments and shreds of the placenta, with clots of blood,
were discharged during the day. Ordered emollient poultices to the
vulva, and warm fomentations to the abdomen ; the vagina to be freely
syringed with soap and water three or four times per day. The opium
to be discontinued, if any symptoms arose to contra-indicate its
use.

July lGth — Morning. Saw her this morning, and learned that she
had experienced two severe rigors during the latter part of the night,
with intense pain in the abdomen, and great sense of constriction and
oppression in the chest. Had also vomited freely twice — skin moist,
but hot, and pulse 140 beats per minute. Administered a full dose of
Sulph, Morphine, which allayed the pain, and composed the bowels,
which were being purged too freely by the Calomel. Suspended the
use of the Opium, ordered light broths, and enjoined rest until the eve-
ning.

Evening. — Symptoms much improved ; skin moist and cool ; pulse
scarcely 100, and soft. Continued the light broths, with instructions
to repeat the opiates, should any untoward symptoms arise. Free dis-
charge from the vulva, containing shreds of the placenta.

July 11th, Visited her this evening, with my esteemed friend Dr.

Dr. Taylor on a case of Spina Bifida.

317

W. H. Moore. Learned that she had experienced some uterine pains
during the night, but no fever. Discharged this morning the remain-
ing mass of the placenta. A large portion of its surface, when it first
came away, presented a fresh appearance, as though it had just been
detached ; the balance of it was black and putrid, and offensive to the
smell. Pulse 96, and the patient entirely free from pain. A slight
diarrhoea existed, for which we presbribed an opiate. Ordered warm
ablutions, a light nourishing diet, and dismissed her. She recovered
perfectly without another untoward symptom.

. Remarks. — It may be thought a useless waste of time to thrust a
report on the profession, upon a subject, from which no practical good
seems likely to result ; but its interest, no less than its novelty, has se-
duced me into it. And besides, by observing nature in her eccentri-
cities, and studying her imperfections and irregularities, we are more
likely to arrive at some knowledge of her mystical laws, than if we
regard her only in her healthy condition. Says a distinguished author,
" By learning what parts she can dispense with, we can ascertain those
organs essential to existence ; and by tracing the deviations from her
common course, we may, perhaps, be led to a more correct acquaint-
ance with her modus operandi."

I am aware that some obstetricians inculcate the doctrine of bringing
away the placenta at all hazards, and if it cannot be detached, to tear
and claw it away piece meal. But I am satisfied that such a practice
is infinitely more perilous in its results than that of leaving the mass
behind ; and besides, it is obvious to the reflecting mind, that a large
mass of the placenta would be more easily and certainly expelled by
the contractile efforts of the uterus, than a number of small, detached
fragments ; while the former may be expelled after a few days, in a
body, the latter must be removed either by a process of putrefaction,
(attended with an offensive and loathsome discharge) or else the more
perilous one of absorption, with its fearful train of consequences.

Four cases of retained placenta from morbid adhesions, and irregular
contractions of the uterus, all of which have terminated favorably, have
fallen within my knowledge in the past two years ; and while I would
by no means be understood to underrate the dangers of leaving the pla-
centa in the womb, I would at the same time venture the opinion, that
there is much less danger in letting it remain than the exercise of undue
force in ( its abstraction. But in either case the strictest vigilance
should be kept, and the first untoward symptom promptly met and sub-
dued.

Talladega, Ala., August, 1852.

318 The New -Orleans Medical and Surgical Journal.

IfL— ON THE USE OF QUININE IN CONTINUED FEVER.

BY E. D. FENNER, M. D., NEW ORLEANS.

The July number of this Journal contains an article from the able
pen of Dr. Boling, " on the use of Quinine in Continued Fever" in
which I find myself so pointedly referred to, as to demand some notice
at my hands. *I must express surprise that my views and suggest-
ions relative to the abortive treatment of continued fever should have
called forth such a criticism without having been honored with a single
experiment by the author. It seems to me that if they were deemed
worthy of notice at all, they should have at least had a trial before
being condemned. Any other course can but appear like a studied
effort to forestal the judgment on a question which can alone be defi-
nitively settled by experience. Before entering into any discussion
with Dr. Boling, it may be well to state briefly the facts and views
I have presented to the profession, and which, it seems, have at-
tracted his special attention.

In the second volume of my Southern Medical Reports there appeared
a short, but extraordinary paper " on the good effects of large doses of
quinine in continued fever" from the pen of Dr. Thomas Fearn of
Huntsville, Alabama, at this time a commission merchant of New Or-
leans, but for many years one of the most distinguished physicians and
surgeons that ever practised in the Southern States. In this paper Dr.
F. gives a graphic account of a terrible continued fever that prevailed
in the year 1831 among a few families residing in the vicinity of
Huntsville, and corresponding very accurately with the descriptions
given of the typhoid fever, at this time prevailing throughout the South-
ern States. That fever proved intractable to all the various plans of
treatment then in vogue ; such as blood-letting, emetics, cathartics, mer-
curial ptyalism, stimulants, anodynes, and the steam or Thompsonian
course. They all failed, and death was slowly but surely sweeping
off every one attacked. In this painful and trying emergency, which
appeared to defy all the known resources of our art, Dr. Fearn, with
the boldness that ever characterizes true genius, resolved to try a des-
perate experiment with the great febrifuge, the sulphate of quinine.
It was determined, in consultation with two other able and experienced
physicians, (Drs. Erskine and Wharton,) that in the case of a young

Dr. Fenner ow the abortive treatment of Fevers by Quinine, 319

lady who had been sick three days with the prevailing fever, when the
most perceptible remission should occur, the sulphate of quinine should
be given in doses of 20 grains, repeated every hour pro re nata. As
the remission was expected to occur about midnight, Dr. F. remained to
superintend the prescription. I quote his words :

"When the fever was at its highest there was slight delirium, great distress about
the precordia, and tenderness on pressure, with rapid, small pulse and hot skin.
When it began to abate, the dose agreed upon was administered. No very sensi-
ble effect was observed, and at the expiration of an hour, the dose was repeated.
Before the expiration of the second hour the pulse was reduced in frequency, and
was softer than it had been since she was taken ill. The skin, for the first time,
was moist, and she was more composed ; nevertheless, the third dose was given at
the end of the second hour. Shortly after she became quite tranquil, and fell into a
sweet sleep — perspired freely—the pulse became reduced from 120 to 80 in the min-
ute, and from that time she was convalescent. Her brother was treated in the same
manner, a few days after, and with the same success."

These are the only cases specially reported by Dr. Fearn, but he
goes on to say :

" The gloom which had hung over the distressed family, and the panic which had
spread through the neighborhood and cut off all communication, except with a few
devoted friends, now subsided. The other sick were put under the same course of
treatment, and all in whom the disease had not progressed too far, were cured. "

I will take this occasion to add what Dr. Fearn told me in person,
although it is omitted in his paper ; It was agreed by the three attend-
ing physicians on the case of the young lady, that the dose of quinine
should be twenty grains ; but there were no scales at hand, therefore it
had to be guessed at. He put out four portions, as near the amount as
he could guess, and having administered three of them, he took the
other to town for the purpose of weighing it. He says it weighed
thirty-two grains, and therefore supposes he really gave the young lady
ninety-six grains of quinine in two hours.

So much for Dr. Fearn's " remarks on the good effects of large doses
of the sulphate of quinine in continued fever." Has Dr. Boling or any
other writer who condemns the use of this potent remedy in typhoid
fever, ever given it such a trial ? If they have published any such re-
ports, I have not been able to find them. But to continue the state-
ment of our position.

At the close of Dr. Fearn's extraordinary paper I appended a some-
what lengthy note, in which I took occasion to express the apprehension

320

The New-Orleans Medical and Surgical Journal,

that late medical writers in the South had perhaps too hastily condemned?
the use of this potent medicine in the treatment of typhoid fever. I
said I did not think any of them had given it a fair trial. I admitted
the difficulty of giving it such a trial in this type of fever, on account
of its slow and insidious manner of attack, and the lateness of the
period when the physician is generally consulted. I maintained that
large doses of quinine, as an abortive remedy, should be given in the
forming stage of fever, or withheld altogether, and that it was vain to
expect ten or twenty grain doses, given at the eighth or tenth day of this
fever, to cut it short. I said farther—

" If the practitioner be not sufficiently familiar with the action of quinine in large
doses, to venture on from twenty to thirty grains in combination with one or two(
grains of opium, and perhaps ten of calomel or blue mass, at one dose, and within
the first two or three days of the attack, we would advise him not to tamper
with this remedy at all, but carefully nurse the patient through the natural course
of the fever- We would not be understood as confidently recommending the abor-
tive method of treating typhoid fever, for our experience has been too limited to au-
thorize us to do so ; but we will say that, if we intended to practice it, something
like the plan just mentioned would be the one we should adopt. We cannot bu*
think that the typhoid fever of the South, which seems to have so greatly increased
oflate years, is one of the Protean forms of endemic malarious fever, and as such,
we should expect quinine to cure it, if rightly administered."

These are the facts and opinions that have been commented on by
Dr. Boling ; let us now examine his comments in the order they appear
in his paper.

He commences by noticing the diversity of opinion that exists among
Southern physicians as to the effect of quinine in continued fever, more
especially typhoid fever, and quotes first Dr. Gibbs of this State, one of
the contributors to my Southern Medical Reports, who, in his account of
the typhoid fever that prevailed in Mansfield, Louisiana, says that "from
the mixed nature and decided periodicity of many of the cases" he was
led to suppose that quinine would prove "a valuable adjuvant" in the
treatment ; but, says he, " after repeated trials, in doses large and
small, I was forced finally to abandon it entirely, as not only useless
in every case, but in many cases decidedly prejudicial to the pa-
tient."

I have only to say, in reference to this testimony, that it is altoge-
ther indefinite, and does not affect my position at all. Dr. G. does not
mention the size of his " large and small doses," nor at what stage of
the disease he gave them. What he says of " the mixed nature and
decided 'periodicity of many of (he cases," will be referred to hereafter.

Dr. F-Snner on the abortive treatment of Fevers by Quinine. 321

Dr. Boling disposes of the testimony of Dr. Fearn in a rather sum-
mary manner. He admits that " the symptoms" (of Dr. F.'s continued
fever,) so far as they are given, correspond very well with those of the
fever now known among us as typhoid fever hut says, farther on,
"he (Dr. F.) does not speak, however, of the post mortem appearances,
and notwithstanding the resemblance, I am forced to the belief, that the
disease in question was not the one now known among us as typhoid
fever. I cannot think it possible that this malady, when established in
a recognizable form, can be cut short by quinine." Now it is some-
what to be regretted that the post mortem appearances of some of the
fatal cases were not given by Dr. Fearn, so as to have removed all
doubts from the minds of those who believe that certain organic lesions
are invariably present in this disease ; but let it be remembered that
this is by no means the unanimous opinion of the profession at this day.
Dr. Fearn could give no autopsies after he adopted the quinine treat-
ment, because the cases all got well. But the last quoted remark of
Dr. Boling would appear to afford a complete clue to his judgment. He
does not think it possible for typhoid fever to be cut short by quinine ;
and therefore, all the supposed cases (no matter how striking the resem-
blance) that are reported to have been cut short in this way, were not
typhoid fever. Now, if this does not show a foregone conclusion, I
should like to know what more would be required. But notwithstand-
ing this strong expression of opinion, Dr. Boling himself appears to
greatly qualify, if not contradict it, in another place, where he says —
" Although I have never myself been able 1o cut short, by the use of
quinine, an unquestionable case of typhoid fever, and although it is
now pretty generally the impression among such physicians of this sec-
tion of Alabama as I have conversed with on the subject, that it cannot
be so arrested, it is more, whatever my own belief, than I would be
willing to assert, that it may not be done." He also makes the follow-
ing candid admission, which leads him into the same dilemma. He
says — " I have never myself given the remedy in typhoid fever to the
extent indeed that Dr. Fearn did in the cases in which he succeeded
with its use, though I have frequently given it in mild cases without
this effect, in doses, with which I am in the habit daily of arresting
with certainty and at once, the most violent attacks of the various forms
of miasmatic fever. Either then my doses have been too small, or the
disease now called typhoid fever among us is different from the cases
which were treated with quinine successfully by Dr. Fearn, and which
he calls typhus, notwithstanding the striking resemblance between
them."

322

The New-Orleans Medical and Surgical Journal.

This is literally begging the question. He has never given Doctor
Fearn's treatment a trial ; but inasmuch as he failed to cut short mild
cases of typhoid fever with such doses of quinine as in his hands ar-
rested violent attacks of the various forms of miasmatic fever, it follows,
either that his doses were too small, or Dr. Fearn's disease was not
typhoid fever — and the latter is evidently his conviction. The abortive
treatment of typhoid fever may turn out to be a vain hope and fallacious
belief, but it will certainly require stronger facts and reasoning than
are here presented to prove it so.

But let us now see how Dr. Boling gave the sulphate of quinine in
typhoid fever, and examine the amount and value of his experience with
the remedy. It will appear to be somewhat contradictory, though he
says he occupies a medium position between Dr. Gibbs and Dr. Fearn.
I will select from his late paper, first, such passages as appear to be
favorable to quinine, and afterwards such as appear adverse ; at the
same time taking the liberty of italicising such remarks as I may deem
worthy of special attention.

1. Dr. B. says :

" In a very few cases of typhoid fever under my treatment, I think I have seen
an unfavorable effect produced by quinine, apparently through a local action on the
gastro-intestinal mucous membrane ; augmenting the already existing irritation of
this part. In a still smaller proportion of cases, I have thought its influence— not
apparently exerted in the manner just mentioned — upon the nervous system, has
been unfavorable ; sometimes it has apparently produced neither a favorable nor un-
favorable effect ; while often its influence has been decidedly beneficial."

I consider the weight of testimony in this paragraph as resting on
the favorable side.

2. Dr. Boling says, that

" In some cases the disease presents somewhat of an acerbative character ;" (pa-
roxysmal I presume he means) and that " in such cases, frequently, though not
invariably, quinine given in pretty full doses, will control entirely, or greatly dimin-
ish the violence of the exacerbations, and in that event, as may readily be under-
stood, its influence upon the progress of the case will generally be favorable ; and I
have seen it thus beneficiaV

I consider this testimony decidedly favorable, because most of the
writers on typhoid fever in this country, particularly in the South, all
speak of the frequent occurrence of this paroxysmal character in the
early stages of the fever. This is the time to cut short the disease ;
and if Dr. Boling had only pushed the remedy more boldly, I have no
doubt he would have succeeded in almost every instance. But then,

Dr. Fenner on the abortive treatment of Fevers by Quinine. 323

as the tenor of his paper plainly indicates, he would not have believed
he was curing typhoid fever.

3. Again, Dr. B. says :

" In cases in which the febrile excitement has been running high — the pulse fre-
quent, the skin hot and dry, and the tongue parched and pointed — with such doses of
the remedy as I have ventured to give, I have sometimes succeeded in subduing the
high excitement — reducing the pulse from 120 or 130, to 90 or 100 — diminishing the
heat of the surface, rendering it, as indeed also the tongue, moist, and the patient's
feelings and condition generally altogether more comfortable — and this improved
condition I have seen maintained for days, under the continuance of the remedy.
Invariably, however, (with exceptions hereafter to be noticed, where there was rea-
son to believe that a favorable crisis took place independently of the effects of the
remedy during the time of its administration) the febrile symptoms have returned on
the suspension of the quinine, and the disease has passed on through its course, ap-
parently unaffected by the temporary interruption in part of its progress ; as if,
though the remedy had exerted its usual controlling influence over the heart and ar-
teries, while continued, it was totally without power or efficacy to neutralize perma-
nently or effect the elimination of the poison or particular cause of the disease from the
system."

In this paragraph Dr. B. confesses that he had seen with his own
eyes the beautiful effects of quinine, even " with such doses as he ven-
tured to give," when "febrile excitement was running high" with all its
distressing accompaniments. In the name of conscience, why did he
not continue to keep his patients in the " altogether more comfortable
and improved condition" in which the quinine had placed them, instead
of yielding up the advantage gained and consigning them to the long
and painful natural course of the disease? I must contend that the tes-
timony is here again favorable ; and I regret that Dr. B. did not push
the remedy a little farther. I now have a case in one of my wards at
the Charity Hospital, in which the fever was fully established at the
time of admission. It resisted my doses of quinine and laudanum (£)i
of the first and 3 ss of the latter) for three or four days, but the pa-
tient was kept comfortable by it and the fever gradually gave way.
About the fifth day of the treatment I gave some small doses of the
Hydrarg. cum Creta and Dover's powder, (the bowels being loose) and
convalescence was very soon established.

4. Dr. B. says —

" It is true that in one or two instances, in which I barely suspected the possibility
of a commencing attack of typhoid fever — the existing symptoms being much such
as might be present in many forms of slight indisposition, and certainly not charac-
teristic of the fever in question — I have succeeded in arresting permanently the pro-

324 The New-Orleans Medical and Surgical Journal.

gress of the disease, or preventing the attack, if one was really threatened, by a full
dose or two of quinine."

Here again Dr. B. displays his usual skepticism. "If an attack of
typhoid fever was really threatened," which he " barely suspected," it
was arrested or prevented "by a full dose or two of quinine ;" but be-
cause it succeeded so well, he evidently doubts whether the cases would
have ever proven to be typhoid fever. Now, claiming as much consi-
deration for my partiality to quinine as for Dr. Boling's prejudice
against it, I may venture to think that the instances in question were
typhoid fever in its forming stage, and that the attack was arrested or
prevented by the treatment adopted ; and furthermore, that if the Doc-
tor had not a little more than " barely suspected" this to be the case,
he would hardly have prescribed full doses of quinine for symptoms of
merely " slight indisposition" This would appear still more strange
if there was no typhoid fever in the family or immediate vicinity. If
there was, it would be favorable to my view ; but this is not stated.
Whenever any dangerous disease is prevailing, whether it be typhoid
fever, yellow fever, or cholera, my rule of conduct is to watch care-
fully the first evidences of attack, and as soon as they are sufficiently
palpable, to resort to efficient remedies. If I arrest or cut short the at-
tacks, some may doubt whether I have had any cases ; but I can enjoy
my own opinion, and my patients have the benefit. As my remedies
will do no harm, even if unnecessarily administered, but a great deal of
good if the attack really is at hand, I prefer to err on the safe side.
Under this plan, if called in time, I hardly ever fail to cut short all cases
of fever; and the result is, that I have not had a case of continued fever
to treat in private practice for three years past. But more of this
anon.

In the same paragraph Dr. Boling mentions the good effects of qui-
nine "in several mild cases," given "on the 14th, and in one, about
the 21st day of fever" — " the favorable crisis which then occurred (he
says) has seemed more decided or marked, than in any cases in which
I have not used it, at about the period of the natural termination."
But here again he displays his skepticism and prejudice as follows : " I
judge that in the instances referred to, a favorable change may have
been about to take place naturally — in part, from an amelioration of
some of the symptoms prior to the administration of the quinine, but
more, because in these cases the remedy, tried at an early period, had
failed to arrest their progress." In these quotations Dr. Boling's obser-
vations are far more valuable than his inferences. He testifies that in

Dr. Fe^ner on the abortive treatment of Fevers by Quinine. 325

several mild cases, quinine given so late as the 14th and 21st day of
fever, seemed to produce a more decided crisis than occurred without
its use; we are at liberty to think what we please of his inferences.

I have already given Dr. Boling's strong expressions in support of
the advantage to be derived from the liberal use of quinine in typhoid
fever, even when it failed to cut short the disease. He goes on subse-
quently to say he had seen " a similar mitigation of febrile action pro-
duced by it not only in the various phlegmasia?, but also in severe cases
of organic disease of a necessarily fatal character, in which it was
merely used as a palliative, to keep in subjection, with the attendant
fever, various unpleasant symptoms, seemingly arising from, or aggra-
vated by it." This is strong testimony in favor of the general remedial
virtues of the sulphate of quinine, and, with what precedes, embraces
the most that is presented on this side of the question in the paper be-
fore us. We will now look to the other side ; and in doing so we shall
have occasion to examine more particularly Dr. Boling's method of
using quinine in typhoid fever.

Dr. Boling professes "great partiality for the remedy," and says he
commenced its administration in typhoid fever with not a little confi-
dence of success, based upon a long and satisfactory use of it in many
other diseases ;" but, it seems, he " was not less astonished than mor-
tified at the result." Now, I have pointed out several instances in
which it seemed to me he displayed any thing but partiality for the
remedy. On the contrary, I think his remarks plainly indicate a fore-
gone conclusion that typhoid fever cannot possibly be cut short by qui-
nine, and that the several mild cases, in which this happy result followed
its use, would have terminated equally as favorably if this medicine had
not been given. The reader will form his own conclusion after all the
facts have been fairly presented. After declaring his 44 great partiality
for the remedy," and confessing his astonishment and mortification at
the result of his experiments with it, Dr. Boling says :

C{ Reflecting upon the probable cause of my failure to cut short the disease in its
progress, by a remedy from which I expected so much, notwithstanding that I
could temporarily control the febrile action, it occurred to me that it might be owing
to an inherent tardiness of the reparative process, in the lesion of the intestinal
glands. With the view, consequently, of preventing, if possible, this intestinal le-
sion, by arresting in its incipiency the fever, the very early administration of quinine
became amain point in the treatment of the disease with me, till, I think, the ex-
periment was fairly tried."

Now, although not disposed fully to agree with Dr. B., in attributing

326

The New-Orleans Medical and Surgical Journal,

the probable cause of his failure to cut short the disease to " an inherent
tardiness of the reparative process in the lesion of the intestinal glands,"
being rather of the opinion that no such lesion exists at the incipiency
of the lever, still I think he hit upon a very happy idea in his determi-
nation to endeavor to prevent this organic lesion and to arrest the fever
in its incipiency by the very early administration of quinine ; but I
must respectfully but decidedly differ with him in his opinion that the
experiment was fairly tried. Let us see now what Dr. B. calls a
fair trial. He says he " gave quinine in typhoid fever, in its various
stages, but without observing any difference in its effects, in any way
connected with or growing out of the period to which the case had ex-
tended." The quotations preceding will show that whenever he used
the remedy, whether early or late in the attack, the effect was generally
salutary — sometimes apparently cutting short the fever, and when it
failed to do this, relieving distressing symptoms, and rendering the con-
dition of the patient "altogether more comfortable." But notwith-
standing these favorable results, Dr. B. unfortunately thought proper to
suspend the use of the remedy ; and then " the disease pursued its or-
dinary course." But how did Dr. Boling give the remedy the "fair
triaV he speaks of?" Dr. Fearn has distinctly stated the plan in which
he gave it and the glorious results that followed ; and I have suggested
what I should consider a fair trial of it. Without having tried either
of these plans, Dr. B. criticises both. Dr. Fearn and myself claim to
have cut short continued fever by the plans we have laid down, and
have therefore the right to claim these plans as a sort of standard by
which to estimate the fairness of a trial. We shall see how near Dr.
Boling's practice comes to this standard. He says :

« As to my cases, in one case I gave twenty grains, repeating it in two hours, and
thirty-six grains daily for the two or three succeeding days, in three doses of twelve
grains each, at intervals of twelve hours, always between midnight and day, suppos-
ing that the febrile action would be less at this time. In other cases, I have given
daily, say two doses of sixteen grains each, or three doses of twelve grains each, at
short intervals, repeated for several days in succession ; and again I have kept up its
continuous operation by doses of eight or ten grains, repeated every six or eight hours
for several days ; and always the result has been much the same. Nor have I neg-
lected any adjuvant measures with which I was acquainted, calculated to secure its
beneficial influence. I have given it in combination with full doses of morphine, and
I have given it without ; I have preceded its administration, where the state of the
bowels would admit of it, with small doses of blue mass ; I have used the warm foot
bath and warm drinks ; and I have used tepid or cold ablution of the entire surface
and cold drinks."

Dr. Fenner on the abortive treatment of Fevers by Quinine. 327

How very different is this plan of Dr. Boling from those followed
by Dr. Fearn and myself. Dr. Fearn gave 96 grains of quinine in the
course of two hours, in doses of 32 grains, and completely arrested a
malignant continued fever which had hitherto proved altogether intrac-
table. Dr. Boling, in one case, gave 20 grains, repeating it in two
hours; and afterwards 12 grains at a dose, to the extent of 36 grains a
day. This is his boldest practice. In other cases he gave two doses
of 16 grains each, followed by doses of 8 or 10 grains, for several days
in succession. He says also that he did not neglect such adjuvant
measures as he thought were " calculated to secure its beneficial influ-
ence," such as "full doses of morphine," small doses of "blue mass,
warm baths, etc." I wish the Doctor had been somewhat more definite
in stating what were his "full doses of morphine," as well as at what
stage of the disease he gave them. But although I cannot for a mo-
ment admit that the methods of using quinine in typhoid fever, descri-
bed by Dr. Boling, allowed the remedy any thing like a fair trial with
a view to its abortive powers, I am happy to find the chief weight of his
testimony is in favor of the generally beneficial effects of the remedy in
all stages of the disease. When it failed to fulfill his most sanguine
hopes and expectations, it still does not appear from his testimony that
it ever proved injurious. This is farther than I have ever gone, though
the observation is supported by the concurrent testimony of Dr. Austin
Flint and others, who have used quinine freely in typhoid fever.

Dr. Boling appears to think it strange that I, after expressing the
opinion that " the typhoid fever of the South is only one of the Protean
forms of endemic malarious fever," should have restricted the use of
quinine in its treatment, to the early or forming stage, when it is gene-
rally admitted, that in undoubted cases of malarious fever, this remedy
may be used with benefit at a much later stage ; and on this he endea-
vors to frame an argument against the correctness of my position. In
reply, I am happy to state that Dr. B. himself, in the paper before us,
has supplied me with all the evidence I might require on this point, as
he gave it with benefit at quite a late stage; and so did Louis of Paris.
If I have been called to any cases of continued fever, whether typhoid
or typhus, within the last three years, or since I have been following
the abortive method of treatment, (and it is but reasonable to suppose I
may have had some,) so far as my memory serves me, I have not failed
to cut them short, and therefore have not had an opportunity, if I were
disposed, to give quinine in liberal doses so late as the 14th or 21st
days of the fever ; but since reading Dr. Boling's favorable account
of its effects, I may make some trials at the Charity Hospital, where

328 The New-Orleans Medical and Surgical Journal.

cases are brought in at all stages of the disease. Now, my reason for
insisting so strenuously on the necessity of giving the large doses of
quinine and opium in the early or forming stage is based on the belief
that at that time the disturbance of the system produced by the morbific
cause is chiefly, if not altogether, functional, and that the important
function of innervation, which to a great extent presides over and regu-
lates all the others, is first and principally deranged ; and I know from
experience that by promptly quieting the first general disturbance of
the functions, which I have succeeded in doing to my entire satisfaction,
by the remedies designated, the progress of the disease is arrested, and
of course, all organic lesions prevented. Nearly all pathologists of the
present day agree,that organic lesions are the results of diseased action,
and not the causes, and hence the importance of arresting, if possible,
the progress, not only of this, but of all fevers, in the early and forming
stage. I have learned from multiplied experience, that this desirable ob-
ject may be readily accomplished by the bold administration of quinine
and opium, with the occasional addition of mild mercurials, in all the
forms of fever that have been presented to my observation in this cityy
excepting perhaps the eruptive fevers; and I have often seen these
most happily controlled by the same means. I know not how far lib-
eral doses of quinine may be useful after inflammation has become set-
tled in a part, producing organic lesion, I confess I have not expected
benefit from the remedy under these circumstances ; on the contrary, I
think I have seen it do harm ; but Dr. Baling has published an inter-
esting paper, in which he claims to have witnessed most beneficial
effects from liberal doses of quinine in the " inflammatory diseases of
miasmatic districts," such as Pneumonia, Bronchitis, etc., etc. ; and
others have seen the same. Although, as Dr. B. supposes, I would-
give quinine in Bilious Remittent Fever at a much later period than that
just dwelt upon, it would only be when I thought inflammation had not
yet become firmly located and produced serious organic lesion. Under
these circumstances I should certainly rely more confidently upon local
depletion, calomel and opium, blisters, and the curative efforts of na-
ture. But if it be granted that quinine may be given advantageously
at a later period in Bilious Remittent than in Typhoid Fever, it would
not invalidate the fact that it may be given more profitably in the earty
or forming stage of both ; neither would it afford any argument at all
against their probable origin from a like malarious source. As before
stated, however, we have the testimony of Dr. Doling himself, and
others equally respectable, that quinine may be given at a pretty late
period of Typhoid Fever, often with benefit, and but seldom, if ever, do-

Dr. Fenner on the abortive treatment of Fevers by Quinine. 329

ing any harm. The celebrated Louis gave quinine, from eight to twenty
grains a day, after blood-letting, and at an advanced stage of the dis-
ease, and commends it more highly than any other remedy. But not-
withstanding this favorable testimony to the efficacy of quinine in the
advanced stages of Typhoid Fever, I am still of opinion that its chief
merit rests on its abortive powers — in other words, that if given early
and boldly, it will cut short the disease.

Dr. Boling thinks that every one particularly interested in the sub-
ject, who reads my remarks, must regret that I did not give the grounds
upon which this conclusion is predicated, and is "led to infer that it is
not based upon his (my) own actual observation." As my remarks
were only appended in the way of a note to Dr. Fearn's paper, I could
not then go more lengthily into the subject, but since they have been
deemed worthy of consideration, I will take this occasion to discuss the
subject a little more fully.

So much of the grounds as rested on the striking testimony of Doctor
Fearn, has already been presented, and is certainly entitled to much
weight. Among all the writers who have condemned this remedy, not
one, so far as I have seen, has ever given it such a trial. Therefore,
having implicit confidence in the veracity of Dr. F., I allow more weight
to his testimony than to all I have seen opposed to it. As for "my own
actual observation," I repeat,that for three years past I have but seldom,
if ever, failed to cut short ail fevers that have come under my care in
the early stages, excepting some of the exanthemata, in which the effort
was not made. Now, how many of these cases were or would have
been Typhoid fever, it is impossible to say ; but as some of them oc-
curred under exposure and circumstances precisely such as gave rise to
Typhoid Fever in others, who were attacked in the same manner, but
were treated differently, I am .led to infer that they were the same dis-
ease. But even if my position be true, how is it possible for me to
prove it to the satisfaction of the skeptic ? Dr. Boling " cannot think
it possible that this malady, when established in a recognizable form,
can be cut short by quinine." But what is this " recognizable form?"
For here lies the gist of the controversy. If the advocates of the spe-
cific nature of this fever cannot recognize its existence before it has ad-
vanced so far as to present indubitable evidences of extensive organic
lesion, I will not dispute with them as to the impracticability of their
cutting it short. But the disease certainly does exist for some days be-
fore organic lesion of any kind takes place — at least such is the opinion
of the best writers on the subject. Why, then, might it not be cut
short in its early stage as well as any other idiopathic fever — Bilious

330 The New-Orleans Medical and Surgical Journal,

Remittent, for instance, which Dr. B. admits may be cut short by qui-
nine ? Those who insist on the uniform presence of what they term
the " anatomical lesion" of Typhoid Fever, the inflammation and ulcer-
ation of Peyer's glands, should show that this lesion actually constitutes
the disease, and that all the symptoms are referrable to it. Otherwise,
they must abandon their position and admit that the aforesaid lesion,
although so often met with, is but a secondary link in the chain of dis-
eased action, and arises from some morbid condition that precedes.
Since the explosion of the Broussaian pathology, there is hardly a single
author of note who does not maintain that the organic lesions which
take place in the course of idiopathic fevers are all secondary in their
appearance ; in other words, that the first effects of the morbific cause
are displayed either upon the blood or the nervous system ; that the first
derangement of the general system is altogether functional in its na-
ture ; and that this derangement of function, if not corrected, leads to
or causes the organic lesions that are found after death.

The able and judicious Dr. Watson, in his lecture on continued fever
says—

" He is sure it is an error to suppose, as many pathologists do, that the fever is
essentially inflammation of those glands (Peyer's) and nothing else." * * * *
"In the first place, if this doctrine were true, it would almost follow of necessity that
the severity of the case and the intensity of the symptoms should be in proportion to
the number, depth and extent of the ulcerations. But this is far from being so. In
cases in which the symptoms have been of the worst kind, there have been found
very few ulcerations, and those small and apparently insignificant. On the other
hand, when the complaint has run a moderate course, but at length has terminated
fatally, it is not uncommon to discover a frightful amount of disorganization in the
ileum. But what is more conclusive is, that the occurrence of this inflammatory con-
dition of the mucous follicles of the intestines is not constant in continued fever. If
one well-marked instance of the disease should occur, without any trace of a morbid
action having been going on in the mucous follicles, that instance would, of course,
suffice to overturn the theory. But scores of such have occurred. I have seen many
such myself; and other persons have seen more." (Watson's Lectures.)

Dr. Bartlett concludes a lengthy definition of Typhoid Fever with the
remark, that " the disease differs from all others, in its causes, in its
symptoms and in its lesions ;" yet he strenuously maintains that the lo-
cal lesion "is not primary but secondary ; that instead of being the sin-
gle cause and origin of the disease, it constitutes only one of its ele-
ments ; and is itself dependent upon some other and ulterior morbid
condition as its cause, the seat, nature and operation of which are not
known to us." Some have thought that Louis maintains a different doc-

Dr. Fenner on the abortive treatment of Fevers by Quinine. 331

trine ; but Dr. Bartlett insists that both Louis and Chomel support the
doctrine here laid down,

Andral denies that the lesion of Peyer's glands is at all essential to
the existence of Typhoid Fever. But I will not multiply authorities on
this point, as there are others that deserve attention, and my paper
is already getting too long.

If, then, the organic lesions which occur in Typhoid Fever are not
primary, but arise from some preceding morbid condition of the system,
the first evidences of which are evinced in the general disturbance of
the functions only, I do not think it at all improbable that we possess
the means of effectually cutting short the disease by the timely correc-
tion of this functional disturbance. In doing this, as Dr. Fearn and
myselfhave done, chiefly by large doses of quinine, it may be denied
that we were treating Typhoid Fever, because that disease was not "es-
tablished in a recognizable form;" still I must insist that it is the best and
safest course to pursue. I contend that it can be done by the method I
have indicated, and none have a right to deny it, save those who have
tried it and failed. That the accomplishment of this desirable object
has been looked for with hopeful expectation, is plainly indicated by
some of the best writers on the subject.

Louis, at the conclusion of his great work on Fever, says :

"The little success obtained hitherto, ought not to discourage the friends of science
and of humanity., and induce them to believe that we shall never arrive at a treat-
ment more appropriate to the disease we have been considering. Who could have
foreseen the effects of opium, and of cinchona, and the preservative virtue of vacci-
nation ? Chance and observation have given rise to these powerful means of preser-
vation : what chance and observation have done, they could do again, and doubtless
they will do so ; and therapeutics, as well as the other parts of our science, must
expect every thing from observation."

Dr. Bartlett writes deploringly of " the unsettled and discordant state
of the professional mind in regard to the therapeutics of Typhoid Fe-
ver," and concludes his chapter on Treatment as follows :

" We may hope that our treatment of the disease will yet become more success-
ful and uniform ; more exact in its application and more positive in its results. Many
« ministers and interpreters of nature,' faithful to their high vocation and competent
to its duties, are zealously and patiently occupied in endeavoring to accomplish this
end. Guided by a sound philosophy; relying upon the one great means of ascertain-
ing the properties and relations of all forms of matter, inorganic or organic, that of ob-
servation, they or their successors may yet find, by persevering experiment or fortu-
nate discovery, methods of modifying the living organization and of correcting its dis-
ordered actions, which shall give us much greater control over the disease than we
now are able to exert." (On Typhoid and Typhus Fevers.)

332 The New-Orleans Medical and Surgical Journal.

Prof. Austin Flint, of Buffalo, New York, Editor of the Buffalo Me-
dical Journal, has recently been publishing in succeeding numbers of
that valuable work, " Clinical Reports on Continued Fever" which, in
minuteness of detail, faithfulness of observation and philosophical in.
quiry, are scarcely at all inferior to the great work of the celebrated
Louis. I am happy to learn that these valuable reports have been em-
bodied in a neat volume, which is just issued from the press. Having
read them as they appeared, I cannot too highly recommend the volume
to the attention of the profession in the South. Let us see what Dr.
Flint thinks of the abortive treatment. I shall take the liberty of itali-
cising at pleasure. In his chapter on " the management of Continued
Fever " he says :

" It has long been a mooted question, whether Continued Fever, when fully
formed, can be broken up by any plan of medical treatment" — that " various mea-
sures for that end have, from time to time, been proposed, but, after a short trial,
have ceased to be employed. This fact suffices to show that no reliable means for
effecting the object have as yet been discovered ; for, if any of the measures proposed
were uniformly, or in a large proportion of cases, successful, their efficacy would
hardly fail to prevent their falling into disuse. The question must stitl be considered
an open one. An opinion on the subject is, of course, but conjectural. Until our
ability to control the course of the disease is demonstrated, we can only judge as to
the probability or possibility of the attainment, by analogy and speculative reasoning.
Both favor the expectation that a specific controlling remedy may, at some future
period, be discovered. Such a remedy has been found in the case of Intermittent
and Remittent Fever, by means of which these forms of febrile disease are rendered
amenable to art. Now, admitting that all essential fevers involve, as their primary
fundamental pathological element, humoral changes due to the action of special poi-
sons, is it too much to hope that the time may come when these changes shall have
been successfully investigated, their character and relations to the poisonous agents
well understood, and science arrive deductively at the knowledge of opposing or
counteracting remedies?"

It seems that Dr. Flint made a limited or imperfect trial with three
remedies, for the purpose of cutting short the fever, viz., quinine, opium
and the wet sheet. It is much to be regretted that he gave the first of
these so imperfect a trial. Nothing like the plan practised by Doctor
Fearn, or that recommended by myself, was attempted to be carried
out. The following is his account of it:

" In two cases, quinine was prescribed with a view to an abortive effect. In both
cases, the fever was fully formed before the remedy was given. In one case, twenty-
four grains of quinine were prescribed in twenty-four hours, on the first day, and
twenty grains on each of the two succeeding days. It occasioned characteristic buz-
zing in the ears, but exerted no appreciable effect on the progress of the disease.

Dr. Fenner on the abortive treatment of Fevers by Quinine. 333

The duration of the fever in this case was eighteen days. In the other case, the
dose given was three grains every six hours, which was continued for six or seven
days. No appreciable effect was observed in this case ; the duration being fifteen
days. Both cases were of the typhoid type.

" In another case, on the first day of admission into the hospital, five grains of
• quinine were given and repeated twice, under the impression it was Remittent Fever.
No appreciable effect followed in this case.

" I have repeatedly prescribed quinia in doses of four or six grains every four or six
hours from the time patients came under treatment, and continued the use of the
remedy in this way for several days, without observing any apparent influence on the
disease."

Now, the only thing that surprises me is, that a man of Dr. Flint's
well known ability — one who ten years ago wrote for the American
Journal of the Medical Sciences, a valuable paper, in which he main-
tained that quinine, given in single doses of 15 to 30 grains, would sel-
dom or never fail to cut short Intermittent and Remittent Fevers, with-
out any previous preparatory treatment—should have offered the above
as a specimen of abortive treatment in Continued Fever ! I can only
say that I should expect no benefit whatever from the remedy thus ad-
ministered- Since my esteemed friend, Dr. F., has had the honor to be
called to the University of Louisville, I do hope he will there take an
early opportunity to give the remedy a fairer trial, and report the re-
sult.

Dr. Flint gave a fairer trial to his other abortive remedies, opium
and the wet sheet, but yet exceedingly imperfect. He admits that the
cases of trial were too few to authorize an induction, yet he thinks they
tend to support the presumption that they do possess more or less power
to ameliorate the symptoms, and to affect both the duration and severity
of the disease"

He then offers the following striking reflections :

" It is by no means improbable that various methods of treatment may be found
to exert more or less control over the intensity and persistence of the morbid condi-
tions upon which Continued Fever depends. This is the fact with respect to perio-
dical fevers. In the latter form of fever, arsenic, strychnia, prussiate of iron, salicine,
etc., are found to have each a specific influence, the quinia being superior to any. So,
in Continued Fever, it should be, not only an object of inquiry, to ascertain a single
plan of abortive treatment which may be, to a greater or less extent, successful, but
to discover different methods ; and finally, by comparisons, to ascertain their relative
value and the circumstances upon which the efficiency of each depends. Should
science at length succeed in acquiring a special remedy, adequate to the objects of
art in the management of this disease, as quinia is in the treatment of periodical
fevers, it will certainly not be more extraordinary than that the latter should have
been discovered ; nor, prior to this discovery, were there stronger reasons for anti-

334 The New-Orleans Medical and Surgical Journal,

cipating it than now exist with reference to prospective success in seeking for the
means of controlling Continued Fever" (Italics mine.)

That is just what I say; but, in the name of conscience, let the abor-
tive plan have something like a fair trial !

I come now to the consideration of a point of great interest ; that*
is, the relationship which subsists between Continued and Periodical
or Paroxysmal Fevers. I shall not attempt to discuss the abstract ques-
tion of whether there is really but one fever, as was maintained by Dr.
Rush, or that there is no such disease as fever, as is proclaimed at the
present day by Prof. Bartlett ; but will take it for granted that we all
understand each other when speaking of the varieties of fever, and will
endeavor to show that there really does exist a very intimate connexion
between Continued and Intermittent Fevers. If I can prove this, it
may serve in a great degree to reconcile the reader to the abortive plan
of treatment which I am recommending in Continued Fevers.

The reader who will go to the trouble of examining the best author-
ities on Typhoid Fever will find that the disease bears a striking re-
semblance to Intermittent Fever in at least three respects :

1. It most generally commences with distinct paroxysms, chills, etc.

2. The spleen is invariably found enlarged after death — generally
recognized before death.

3. The disease prevails mostly in autumn,
Louis says, that

" In patients who died of the Typhoid affection, 31 out of 33 subjects from whom
he was able to learn any thing definite in relation to this point, had chills, and the
whole of them, with merely six exceptions, from the beginning of the disease. * *
Though often slight, they were severe and accompanied by trembling in a quarter of
the patients." " Five of them had only one chill, but this symptom occurred more
or less frequently in the others, in the cold as well as during the warm seasons.
Fourteen of them had some, frequently the first eight or ten days ; six for the
space of from two to three weeks and more." * * * In the patients who re-
covered, all in whom the affection was severe, with the exception of three out of
forty -five, had chills, or a great sensibility to cold. Six experienced the latter. Nine
had a single chill. Chills returned many times during a space of from eight to fifteen
days in the others, in the same circumstances as in the subjects who died," etc.

These chills, Louis says, w7ere followed by heat and perspiration.
In his 44th Observation, he says the disease " began, to a certain de-
gree, like a quotidian fever ; the chills returned regularly during eight
days." On the fourth day, 8 grains of quinine were prescribed, which
promptly arrested the chill ; but this remedy was suspended, and the
patient died on the 16th day.

Dr. Fenner on the abortive treatment of Fevers by Quinine. 335

Dr.'.BartJett says, " The disease is attended at its commencement
with chills or rigors, not commonly very severe, and usually repeated
at uncertain intervals for the first few days."

Prof. Flint, in his second Clinical Report on Continued Fever, says
of chills — "In twenty-one cases of the typhoid type, the histories state
distinctly that chills were, or were not present. And of this number of
cases, one or more chills marked the access in all but one case, i. e. in
twenty cases." The chills were followed by increase of heat in twelve
out of the fifteen cases in which this symptom was noted ; and there
was perspiration in ten.

Any amount of testimony could be adduced to substantiate this point,
but I have neither time nor space. Let us come nearer home. It will
be recollected that Dr. Boling makes the following admission : " In
some cases the disease, as it appears with us, presents somewhat of an
acerbative character; more so, it is probable, than at the North." If
the latter supposition be true, the point may be considered settled —
judging from the testimony previously given. But Dr. Gibbs, the first
writer quoted by Dr. Boling, speaks of " the decided periodicity and the
mixed nature" of many of the cases that came under his observation.
In short, so far as my information extends, such is the general charac-
ter of the disease at its commencement, throughout the Southern coun-
try. I can at least assure Dr. Boling that this corresponds entirely
with my " own actual observation."

Let us now look to the second point of coincidence between Typhoid
and Intermittent Fevers, viz : the enlargement of the spleen.

Louis found this organ in its natural condition only four times in forty -
six examinations. (Op. Cit.) It was generally enlarged and frequently
softened.

Dr. Bartlett says, " The spleen is almost always more or less alter-
ed in its appearance. The most constant change consists in an aug-
mentation of its volume. In many cases it is three or four times as
large as it is in its natural state. It is also very much diminished in
consistence."

Dr. William Jenner, Professor of Pathological Anatomy in Univer-
sity College, London, has recently published some valuable observa-
tions on Typhoid and Typhus Fevers, in which he attempts to determine
the question of their identity or non-identity by an analysis of the symp-
toms and appearances after death. I find the following quotation from
him in the work of Dr. Flint. In a " synopsis of morbid appearances
in sixty-six cases," I find the following remarks respecting the spleen.

33G The New-Orleans Medical and Surgical Journal,

" This organ was enlarged in all the cases of Typhoid Fever — softened in one
third of the cases only. Before the age of 50, it was as large after Typhus as Ty-
phoid Fever ; after that age, it was decidedly smaller in the former than in the latter
affection."

I will not multiply quotations on this point ; suffice it to say there is
a general concurrence in regard to it.

On the 3d and last point of coincidence, i. e. the greater prevalence
of Typhoid Fever in the autumnal months, I shall not insist so strenu- ,
ously, though it is by no means wanting of testimony. Dr. Bartlett
says :

" It is by no means settled whether Typhoid Fever occurs, with any degree of
uniformity, more frequently in one season than another. The common impression, I
think, in New England is, that it prevails oftener in autumn. Dr. James Jackson
says, expressly, that such is the fact ; although he admits that it may be seen any
month of the year. am Very sure, however, that as a general rule

its annual prevalence is greatest in autumn. In New England it is not unfre-
quently called the autumnal or fall fever."

On this point, Dr. Flint gives the particulars of twenty-nine Typhoid
cases and ten of Typhus. After giving the results, he thus concludes : '

" These results accord with the more extended observations from which it has
been deduced, that while Typhoid Fever is much more liable to occur in the autum-
nal than in the other months of the year, Typhus occurs irrespective of season."

I think it is well known throughout the Southern and Western States,
that in sickly years, the cases of fever which occur late in autumn have
a much stronger tendency to take the continued type than those which
occur earlier. Even the Yellow Fever of New Orleans, in October
and November, not unfrequently runs on to the 15th day.

In respect to the relationship between Continued and Intermittent
Fevers, I would invite the reader's special attention to the following
extraordinary conclusions of that cautious and faithful pathologist,
Louis. After carefully comparing all the prominent symptoms that
belong to the Typhoid affection with analogous ones in Intermittent Fe-
ver, Louis says :

" Thus the morbid changes in organs and f unctions observed during the course
of continued fever were observed, likewise, in those which were intermittent. The
difference consisted in hardly any thing more than degree. A rather large number
of patients had pains in various parts of the abdomen, diarrhoea, nausea, vomiting,
redness and dryness of the tongue, redness and pain in different parts of the fauces,
connected in some cases with very marked swelling, many species of eruption upon

Dr. Fenner on the abortive treatment of fevers by Quinine. 337

the surface of the body and on the lips, anxiety, delirium ; so that whatever was the
cause of the febrile action, continued or intermittent, we see it always accompanied
by derangement of the same functions, changes in the same organs ; and this con-
nexion or dependence must appear the more evident from the fact that the alteration
of the functions was frequently limited to the time the access continued."

These conclusions of Louis are based on the minute observation of
about forty cases of Intermittent Fever, for the purpose of comparison.
His Translator, Dr. Bowditch, objects to the inference from the above
remarks, that Louis thinks Typhoid and Intermittent Fevers are of the
same nature ; but I cannot see what other meaning is conveyed by his
words.

A great deal more might be said on the subject, but I am afraid of
wearying the reader. I trust I have already said enough to show, that
although no standard authority admits that Typhoid Fever can be cut
short by any method of treatment they have seen practised, yet they
evidently think it not at all improbable that some successful plan will
be discovered for the accomplishment of this desirable object ; and that
the plan proposed by the writer is supported by reason and analogy, as
well as by some experience. I do not contend that this is the best or the
only plan ; but merely that it may be done in the way I have indicated.
I would not advocate a lull-or -cure practice in any disease ; for experi-
ence has taught me that much may be expected from the efforts of Na-
ture— that we should follow her indications and aid her efforts, but be
extremely cautious in the use of those remedies, which, if they fail to do
good, may do irreparable injury.

Dr. Watson says he agrees with Pitcairn, who, being asked what he
thought of a certain treatise on fevers, declared, " I do not like fever
curers. You may guide a fever; you cannot cure it." Yet Dr. Wat-
son, a few sentences previous, had laid down the doctrine that " the
proper view to take of jever was that which the Toxicologist would
take. The disease is produced by a poison, of which the injurious im-
pression upon the animal economy at length ceases, or passes off, of
itself; in the same manner, only more slowly, as the influence of a dose
of opium will spontaneously pass away. But during the natural course
of the fever, as in many cases of poisoning, morbid processes are apt to
be set up, which, if suffered to proceed unchecked, would inflict irrepar-
able injury upon important organs, and which are fairly within the scope
of remedial agency.'''' Now, with due deference to this high authority,
I must insist, that if the method proposed by me will promptly cut short
those morbid processes in the early stage of fever, which, if suffered

338 The New-Orleans Medical and Surgical Journal.

to proceed, would inflict irreparable injury to important organs, (as I
firmly believe it will,) it is exactly equivalent to curing fever ; and so
far, I am in favor of fever-curers.

Much might be said respecting the essential nature of the causes of
Continued and Paroxysmal Fevers ; some supposing them to be entirely
different ; the former having an animal origin, and always contagious,
the latter a vegetable origin, and seldom or never contagious ; but I am
compelled to forbear for want of space. The question is still a mooted
one, and far from being settled. So far as this question involves the
propriety of the abortive treatment, we have so lengthily discussed —
seeing that Typhoid Fever has spontaneously sprung up in all parts of
the Southern country where endemic malarious fevers prevail, and be-
lieving that it is equally controlled by the same remedies, I am irresist-
ably led to the conclusion that its origin or cause is essentially the same,
though modified by circumstances.

It may not be generally known that the distinguished Dr. John Arm-
strong, who wrote on Typhus and other fevers, after contending for
years that Typhus Fever was exclusively of animal origin and always
contagious, lived to discover his error, and like our immortal Rush, had
the magnanimity to confess it. In the Appendix to his great work on
Typhus, he said he was convinced that he had seen genuine Typhus
Fever spring from the same causes that give rise to Intermitients and
Remittents. Dr. John Bell, in his Lectures, (Bell and Stokes' Prac-
tice) says : " Whatever importance may be attached to this opinion (of
Dr. Armstrong) in Great Britain, and I believe that it does not obtain
much favor there, it comes nearer an explanation of the typhoid form of
fever, by which I mean that resembling typhus, that we meet with in
the United States, than the commoner one of contagion by specific vi-
rus or animal poison."

In a very able paper by Dr. G. A. Ketchum of Mobile, " on Perio-
dicity in Disease, in the last volume of the Proceedings of the Alabama
State Medical Association, I find the following confirmatory remarks :
" From the facts we have stated, and the authority which abounds on
almost every side of us, the conclusion is forced upon our minds, that
all fevers, whether of the strictly intermittent, or mere continued
variety, constitute at bottom and by their true nature, the same disease —
that they differ only by their type. For we know that they all can be re-
ciprocally transformed^ the one into the other, and that we may see the
same attack assume the intermittent, the remittent, or the continued form
and that almost invariably when the disease assumes a threatening or

Dr. Fenner on the abortive treatment of Fevers by Quinine. 339

grave aspect, whatever may have been its type at the commencement,
it will assume the continued form for some time before its final termina-
tion. Again, we see that the same cause will develop the intermittent
or the continued form, the character and peculiarities of the individual
determining the one or the other."

I am happy to find myself fully supported by this able practitioner*
in all my views respecting the origin and relationship of fevers, as well
as the abortive powers of the sulphate of quinine.

With a brief allusion to one more of Dr. Boling's remarks, I will
close. He says :

"I am inclined to think that Dr. Fenner does not differ much more from the profes-
sion generally, in his opinion that Typhoid Fever may be cut short and permanently
arrested in its course by quinine, than he does in his recommendation of calomel, in
this malady, as a general practice, in the dose of ten grains. Judging from my own
experience of the disease, as it has prevailed here for the last two years, I would say,
that few cases indeed occur, in which a single ten grain dose of calomel would not
exert a prejudicial influence ; and that administered generally, it Would have the
effect of increasing the mortality at least three or four per cent."

The remark of mine that called forth this criticism is as follows : "If
the practitioner is not sufficiently familiar with the action of quinine in
large doses to venture on from 20 to 30 grains, in combination with
one or two grains of opium and perhaps ten grains of calomel or blue
mass, at one dose, and within two or three days of the attack, we would
advise him not to tamper with this remedy at all."

It will be seen that I do not recommend the 10 grain doses of calomel
as a " general practice ; - but merely intimate that it may sometimes be
a valuable addition to the quinine and opium in the early stage of
the fever. I am of the same opinion still, notwithstanding the ex-
pressed apprehensions of Dr. Boling, who, it seems, has not given this
remedy even so fair a trial as he did the quinine. So far as I have
looked, I find that nearly all writers on Typhoid Fever recommend
mercury in some form, and the latest Essayest I have seen, Dr. Cain
of Charleston, places his chief reliance upon it. But I only recom-
mend it as an assistant abortive remedy, to be given in the early stage
of the fever.

Here I am compelled to stop, though feeling that I have done nothing
like justice to the subject. I sincerely hope I have said nothing in this

340 The New-Orleans Medical and Surgical Journal.

paper that can be in the slightest degree offensive to my esteemed
friend Dr. Boling, and beg leave to thank him for the attention he has
directed to my peculiar views.

IV. — CAHAWBA, ALABAMA — ITS PREVALENT DISEASES— VENE-
SECTION IN CONGESTIVE FEVER— TYPHOID FEVER, &c.

A. Hester, M. D.

Dear Sir — We have had a more sickly summer in Cahawba and
vicinity than for many years past. I attribute it to the heavy and fre-
quent rains that fell in July and August. Fevers of almost every type
have prevailed amongst us — Bilious Remittent, every form of Intermit-
tent, and different grades of Typhoid, and also one case of Congestive.
Bilious Remittent and Congestive had formerly been the prevailing
type of malarial fevers with us, but for several years past it was ex-
ceedingly rare to meet with either. Summer had become our healthy
months, and warm weather was looked for with almost as much anxiety
as were formerly the frosts of October.

This year, however, Bilious Remittent has been the prevailing type.
It was characterized at the commencement by a well marked chill, or
sometimes by only chilly sensations, succeeded by hot and dry skin,
full and bounding pulse, thirst, restlessness, pain in the back and head.
The tongue was generally coated with a yellowish fur ; sometimes,
however, it was whitish, with red edges; sclerotic coat yellowish; urine
high colored and small in quantity. These were the most prominent
symptoms which marked this form of the disease. A free, spontaneous
vomiting of bile occurred in some cases.

The treatment of the above form of fever was simple and remarkably
successful. An antimonial emetic was given, followed by an active
cathartic, in which calomel was a main ingredient. This was suc-
ceeded by 4 or 5 grain doses of quinine. Sometimes, when there was
great restlessness and nervous irritability, nitrate of potash, in 10 grain
doses, with three or four of Dover's Powder, was combined with the
quinine. After a few doses had been administered, at intervals of two
hours, free sweating supervened, the fever went off and did not return.
In cases where emesis occurred of itself, it was promoted by copious
draughts of warm water, with great relief and benefit to the pa-
tient.

The case of Congestive Fever alluded to above, was characterized

Dr. English on the Diseases of Cahawha.

341

by great coldness of the whole surface, except the upper portion of the
chest and head, excessive restlessness, irregular respiration, or the fre-
quent efforts " to get a long breath," an occasional expiratory effort,
with a whistling sound, as of one greatly fatigued from violent physi-
cal exertion; the patient complained of great oppression. The tongue
was shrunken and of a slightly bluish cast ; the stomach was exceed-
ingly irritable, a small portion of cold water being rejected in a few
minutes after being swallowed; the pulse was small and 130 in a min-
ute. I was informed that the patient had been in this condition for 12
or 14 hours. The bowels were constipated. I administered several
remedies with a view to allay the irritability of the stomach ; they
were rejected almost as soon as swallowed. I cupped him freely over
the region of the stomach ; applied sinapisms with hot mush poultices,
smeared over with spirits turpentine — all had no effect in calming the
sick stomach or bettering the condition of my patient. Finding that no
internal remedy was available, and that external ones had done no
good, and believing that my patient could not remain long in this state
Avithout some serious lesion supervening, which would destroy him, I
resolved to take blood from the arm, with a view to restore the lost bal-
ance of the circulation. I was the more ready to hazard this remedy
from the fact that my patient was in the prime of life, vigorous, of
sound constitution, and in fine health previous to his present attack. I
opened a vein ; the blood was very dark and thick at first ; after about
a pint had been taken he remarked, " I can now get a good breath."
His pulse became fuller and slower. When he had bled about a pint
and a half I arrested it. He remarked that he felt as if a great load
had been taken off of him. The surface became evidently warmer,
and the patient was more composed. I had his feet and legs put in
a tub of hot water and mustard, and kept in for an hour, occasion-
ally adding hot water, to keep up the temperature. During this time
he became very hot, and his stomach became quiet. I now com-
menced the exhibition of 4 grains calomel, 5 of quinine and one eighth
morphine, every two hours. After two or three doses free perspira-
tion followed, and the bowels were acted on. The quinine was kept
up at longer intervals for twenty-four hours ; his fever went off and
did not return. He convalesced very rapidly.

I would by no means be understood as advocating the use of the
lancet in all such cases. I resorted to it as a dernier remedy under
almost desperate circumstances. In this case it was evidently the
means of unloading the internal blood vessels, and diffusing the
blood to the surface.

342 The New-Orleans Medical and Surgical Journal.

I find that my letter has grown to a much greater length than I in-
tended. I have treated this spring and summer some twelve or thir-
teen cases of Typhoid Fever, with but one fatal termination. I may
on some other occasion say something in regard to their character and
treatment.

Most respectfully yours,

J. A. ENGLISH, M. D.

V.— HISTORY OF THE MISSISSIPPI STATE HOSPITAL AT
NATCHEZ.

BY C. S. MAGOUN, M. D., PHYS. AND SURG.

On the 20th of November, 1804, a circular was issued by seven of
the medical practitioners of Natchez, to the inhabitants of the Missis-
sippi Territory, setting forth the necessity of a Hospital for the suffer-
ing and destitute, and soliciting subscriptions and donations for this
purpose. They offered their gratuitous services, as might be required,
and called a public meeting of all those interested, or willing " to give
encouragement to the proposed institution, to meet at the City Tavern^
in Natchez, on Saturday, the 22d day of December, 1804," to memo-
rialize the Legislature on the subject. The names of the Physicians
making this call, and taking this initiatory step, were as follows :

Doria Latimer, G. C. Pendergrast,

Wm. Lyon, Joseph Mecrery,

James Speed, Andrew Mecrery,

Frederick Seip.

The meeting was held in accordance with the call, and a memorial
addressed to the Legislature on the subject.

In the following month, January 18th, 1805, an act was approved,
" To establish a Hospital in the city of Natchez, and for incorporating
Trustees of the same." The following is the preamble and first sec-
tion of the act of incorporation :

Whereas great numbers of sick and distressed boatmen, employed in the naviga-
tion of the river Mississippi, and other indigent persons, destitute of the means of
procuring medical assistance, are found in the city of Natchez and other parts of this
Territory, for the relief of whose wants private charity and present legal regula-
tions are inadequate, and subscriptions to a considerable amount having been raised,
and the sum of one thousand dollars bequeathed, by the late George Cochran, Esq.,

Dr. Magoun's History of the Mississippi Slate Hospital. 343

for the purpose of establishing a Hospital in said city. And whereas David Latimore,
Garret E. Pendergrast, William Lyon, Joseph Mecrery, James Speed, Andrew Me-
crery, and Frederick Seip, physicians of that place, have humanely proffered their
professional services gratis, for the benefit of such an institution. —

Section 1. Be it therefore enacted by the Legislative Council and House of Rep-
resentatives of the Mississippi Territory, in General Assembly convened, That there
be erected and established in the city a Hospital for the reception and relief of indi-
gent boatmen, and other paupers of every description in this Territory, who may be
in want of medical aid and assistance, and who, if without the limits of the city,
may be sent thither by the order of any justice, at the expense of his proper county,
to be called and known by the name of the " Natchez Hospital," to be under the
care, government and regulation of a body politic and corporate, as hereinafter pro-
vided.

Section 8th provides for an annual appropriation of one thousand
dollars for five years.

The Trustees, as designated in the act of incorporation, met for the
first time in the Court House, on the 12th day of April, 1805. After
being organized, the following resolution was passed :

" Resolved, That a committee of three be appointed to examine and report a place
most eligible for fixing the Hospital, and also to report a plan for the building, and
the quantity of land that may be necessary for the garden and burial ground."

At the next meeting, 19th of April, the committee reported. Having
selected the grounds now occupied by the Hospital, they were instructed
to negotiate and procure the same from Maj. Stephen Minor. No other
meeting was held this year. On the 8th day of April, 1806, a meeting
was convened, and rules and regulations adopted for the government of
the Board.

The committee on the purchase of a site for the Hospital, report that
they had bargained with Major Minor for six acres of ground, at six
hundred dollars, which was approved, and the committee authorized to
confirm the purchase. At this meeting a committee was appointed to
receive proposals for building the proposed Hospital, according to such
plan as the committee might approve.

The next meeting took place on the 1st of October, 1807. The
committee on proposals for the building did not report, but a memorial
was made to Congress, praying for aid in carrying into effect the ob-
ject of the corporation. Here the matter rested, so far as we know,
till December 9th, 1811, when the Trustees held a meeting, and a com-
mittee was appointed to " memorialize on the subject of an endowment
to the institution, which committee reported, and submitted a memorial
to Congress, which was adopted December 16th, 1811. In the fall of

344 The New-Orleans Medical and Surgical Journal.

this year another meeting was held, and the committee again charged
with the duty of closing the contract for a site for the Hospital. A plan
of the contemplated building was also before the Board, and it was
adopted. Friday, the 18th day of June, 1813, the plan previously
adopted was rescinded, and one adopted in the place of it of smaller
dimensions, and which was the plan of the present main building. Pro-
posals were submitted to the Board, July 17th, 1813, for erecting the
building, and in December following various contracts were entered
into for the erection of the Hospital ; and during the year 1814 it was
in process of erection. Up to this time the Trustees had the appro-
priations of the Territory ; also five hundred dollars from the State of
Tennessee, one or two legacies, and the funds arising from the license
of biliard tables in the city of Natchez. The Trustees met on the
21st of August, 1817, and resolved that the Hospital be provided with
a matron, servants, and all requisites for the reception of patients. No
mention is made further in the records till the 3d of August, 1819, when
it was unoccupied, and it was given up to the overseers of the poor, for
the purpose of carrying it on. The Trustees resolved "to enclose the
lot and procure a supply of water by digging a well or cistern," and
to repair and furnish the building, so as to go into operation. How
long this arrangement lasted is not known ; but on the 6th of August,
1821, at a meeting of the Trustees, it was resolved, "That the use
and possession of the Natchez Hospital and the furniture therein, be
granted, for the term of six months, to Dr. Perlee, and others associated
with him, for the purpose of taking care of such sick and infirm persons
as they may deem fit subjects for the Hospital.'5 Resolutions were
also passed making the necessary provision for carrying it on. The
Trustees, February 27th, 1822, returned a vote of thanks to Dr. Perlee
and others, for their humane, skilful and gratuitous services during the
past six months ; and the physicians of Natchez were invited to con«
tinue such services.

The first medical account given of the institution was made by Dr.
Perlee, the attending physician, on the 11th of July, 1822. It was
approved, but not put upon the record, so that no knowledge of its con«
tents can be known.

A resolution was adopted July 6th, 1822, admitting to the benefits
of the Hospital all sick and needy persons, not citizens of this State.
On July 9th, 1823, we find that Dr. Perlee had resigned the office of
President of the Board and Physician, and removed to New Orleans,
The Trustees returned to him a vote of thanks "for his unaided and!

Dr. Magoun's History of the Mississippi State Hospital. 345

gratuitous services at the Hospital," etc., and invited the medical fa-
culty to afford medical assistance, under such regulations as they might
prescribe. In response to this invitation, at a meeting of the Board
a few days after, Drs. Gustine, M. and W. Pedran, Chew, Denny,
Merrill and Watkins, offered their professional services gratis for the
season, which were thankfully received.

This year the city was visited by the most appalling and fatal epi-
demics ever known* Nearly one third of the entire population fell vic-
tims to the disease. Many persons fled ; all business was suspended.
The Post-office, Bank, etc., were temporarily removed to the country.
Large numbers died in the Hospital, and all its available means were
exhausted. Subscriptions were raised in this region and New Orleans
to sustain it. Some time after this the Hospital was closed. The
Trustees, at a meeting held March 12th, 1825, resolved, "That the
Hospital be rented to Capt. R. Wash, for the use of the United States,
at the rate of thirty dollars per month."

From the last date there is no record extant of any meeting of the
Board of Trustees till March 15th, 1836, being a lapse of ten years.
At this meeting Dr. E. P. Pollard was elected physician for the term
of six years. The Legislature, February 5th, 1836, amended the act
of incorporation in many particulars, giving full and unlimited powers
to the Trustees to have the Hospital conducted in such a manner as
they might deem best, and increasing the number of Trustees from
seven to seventeen. A meeting of the Trustees was held March 26th,
1836, at the Mansion House, and the committee appointed at a previ-
ous meeting, reported as follows : The committee appointed to examine
the present state of the Natchez Hospital report, that they have visited
the building, and find it in a most ruinous condition, entirely perverted
from the intention of its original founders, used as a pest house, and
occupied by negroes," etc. At this meeting John Henderson resigned
his office of Treasurer, and membership in the Board, " owing to the
infirmities of age ; having served nearly thirty years." He also paid
over to the Trustees the balance in the treasury, amounting to $7,295
66. A committee was appointed to have the Hospital repaired, the
grounds fenced in, etc.

What time the Hospital was opened this year is not stated ; but the
resident Physician and Surgeon made a report, which was agreed to.
At a meeting January 3d, 1837, the following resolution was adopted :
Resolved, that the salary of the Physician and Surgeon of the Natchez
Hospital be two thousand dollars per annum from the time he took

346 The New-Orleans Medical and Surgical Journal.

charge of the institution, and that it be paid quarterly. An act to change
the name of the Natchez Hospital and for its relief and benefit, was
passed February 14th, 1839, changing its name to the Mississippi State
Hospital at Natchez, and making an annual appropriation for three
years of five thousand dollars. Section 2d of the same act constitutes
the Mayor of the city of Natchez President ex-officio of the Board of
Trustees, and requires an annual report to be made to the Governor of
the State.

Meetings of the Trustees were held several times in the years 1839
and 1840. In January, 1841, the Trustees had ordered the Physician
and Surgeon to admit no more patients, and appointed a committee to
confer with the overseers of the poor to take the patients then on hand
in the Hospital. The Physician and Surgeon, E. P. Pollard, offered
to take the Hospital on his own account, which the Trustees accepted.
About this time the Hospital was again closed, its resources all ex-
hausted and largely involved in debt. The State appropriation had
ceased to flow into the treasury, and the Hospital was dependent for re-
sources upon the city licenses to retail spiritual liquors. The Trustees
held a meeting January 27th, 1844, and resolved, " That D. H. Lane
be permitted to use the Hospital and grounds as a private residence,
until such time as the Trustees might need it, upon condition of taking
satisfactory care of it.

The Trustees again met in May of this year, and appointed a com-
mittee to afford relief to proper diseased objects of charity, and report
to the Board the names of all relieved, and the amount expended on
each. The committee in July reported thirteen relieved, costing in
the aggregate $124 75.

The next meeting was held August 10th, and it was resolved " To
open the Hospital, and to employ a Steward, Physician and Surgeon,'
etc. The Treasurer reported upwards of two thousand dollars in the
treasury. Dr. F. A. W. Davis was elected Physician and Surgeon,
and commenced his duties August 15th, 1844, at which time it " went
into full and complete operation."

October 3d, 1844, was the regular time of holding the quarterly
meeting of the Trustees, and the Executive Committee reported, from
which we make the following extracts : " Twenty-seven patients have
been admitted since the 15th of August. Of these fifteen have been
discharged cured, six have died, and six are now remaining in the Hos-
pital." This is the first showing upon the records of any medical re-
port, notwithstanding the records of the institution date back fifty years.

Dt\ Magoun's History of the Mississippi State Hospital. 347

The whole number of patients admitted to the close of the year were
as follows : Admitted fifty-five ; died eight. Discharged cured forty-
five ; not cured one, and one remaining. Thirty-two were born in fo-
reign countries. The Hospital was conducted on the plan upon which
it was first opened, for the years 1845 and 1846, and Dr. Davis was
continued as Physician and Surgeon. The salary was fixed at one
hundred dollars per quarter, or four hundred dollars per annum. In the
year 1845 there were admitted ninety-two; discharged cured sixty-five;
died six. Born in foreign countries forty-eight. In the year 1846 there
were admitted one hundred and fifty-three; discharged one hundred and
seven ; died forty. Most of the mortality this year occurred among the
sufferers from the steamboats " Queen City" and " Maria ;" a large
portion of whom were emigrants. In the year 1847 the Trustees en-
tered into new arrangements for conducting the Hospital. Proposals
were received from Dr. L. P. Blackburn to take the entire charge of
the institution on his own account ; receiving from the Trustees the
receipts accruing to the Hospital from the sale of licenses in the city of
Natchez. This plan of arrangements, with slight alterations, has been
continued up to the present time. The Physician and Surgeon has
been permitted to receive pay patients, under the restriction that they
must not interfere with the welfare of the charity patients. The allow-
ance received from the Treasurer has varied from twenty-five hundred
to thirty- five hundred dollars per annum. Quarterly reports are made
by the Physician and Surgeon to the Trustees, and since the previous
date, no interruption has taken place in the management of the insti-
tution.

In the year 1847 were admitted 146; discharged 132; died 12. The
Legislature, in 1848, made an appropriation of four thousand dollars
for enlarging and improving the Hospital. A part of this amount was
expended in building a wing to the former edifice, and making neces-
sary repairs. Number admitted this year 176; discharged 158; died
16. In 1849, admitted 256; discharged 185; died 35. In 1850, ad-
mitted 234; discharged 184; died 21. In 1851 were admitted 257;
discharged 206 ; died 23.

Since the re-opening of the Hospital, August 15th, 1844, to the close
of the year 1851, there has been admitted 1399. The deaths amount
to 171 — making the percent of mortality 12.232.

During the present year the Trustees have thoroughly repaired and
put in good order the building, and added new furniture. The Hospital
has good accommodations for twenty-five patients. The Executive

348 The New-Orleans Medical and Surgical Journal.

Committee in their last report, April 1st, 1852, make use of the follow-
ing language : u The committee find the Hospital in a clean, neat, and
really satisfactory condition."

It will readily be perceived by the foregoing brief sketch of this in-
stitution, that it has undergone many vicissitudes and changes, and of-
tentimes struggled hard for the means of support. It is now free from
debt, and its annual income promises to be ample to keep it in success-
ful operation for years to come. Its records are deficient ; and much
medical history that should have been preserved is forever lost. The
institution is becoming venerable with age, compared with similar in-
stitutions in this part of the country ; and its present directors appear
to be actuated by an ardent desire to make the institution worthy of the
place, and a lasting blessing to the suffering sons of want, from what-
ever land they come.

VI. — THE MOTIVE POWER OF THE BLOOD.

BY ALBERT WELLES ELY, A. M. M. D., NEW ORLEANS.

Since writing my first paper on this interesting subject, in the July
number of the New Orleans Medical and Surgical Journal, I have had
the pleasure of reading five articles on the subject from the pen of Dr.
Samuel A. Cartwright, four of which were partly in reply to my first
paper. I now propose to review briefly these last five papers of Dr.
Cartwright, for the purpose of discovering what progress has been
made towards establishing the very singular theory of Dr. Cartwright
and Mrs. Willard, that "the chief motive power of the blood is located
in the lungs and derived from respiration ;" or, as stated by Dr. Cart-
wright, " that a haematokinetic power is generated in the lungs by res-
piration sufficient of itself to propel the blood through the pulmonary
veins to the heart, and from thence, with or without its help, through
the arterial system."

Dr. Cartwright continues to assert, without having invalidated any of
the proofs of the utter untenability of his theory, given in my first pa-
per, in July, and without adducing any new proofs in support of his po-
sition, that his theory is nevertheless correct ; and that his alligator ex-
periments, the microscopic observations of Prof. Riddell, and also the
case of the child reported in the last number of the New Orleans Medi-
cal and Surgical Journal, have completely silenced his opponents. He

Dr. Ely on the Motive Power of the Blood.

849

claims a victory over all, and attempts to convey the impression that his
alligator experiments have nearly if not quite settled the question.

We have been hesitating some weeks about the propriety of replying
to the papers of Dr. Cartwright, on account of the manner in which
he attempts to meet the arguments brought against his theory ; but our
high regard for Dr. Cartwright, and the fear that he might construe our
silence into something like disregard, not to say contempt, of his paper,
have induced us to resume the subject.

It is quite unnecessary for me to remind my worthy and distinguished
opponent, that the tone and manner of his four last papers, both in the
Boston Medical and Surgical Journal, and in that of New Orleans, are
entirely unsuited to grave, scientific discussion. Let brawling politi-
cians indulge in sarcasm, irony, ridicule and broad assertion, if they
choose ; let them issue their "bulletins of victory," declare one another
hors de combat, "unhorsed," "put down," " in the woods," "in cap-
tivity," etc., as much as they please — for such seem to be the legitimate
weapons of political warfare — but never suffer them to be taken up in
the cause of pure science. Such things are quite out of place in scien-
tific discussion. Ridicule and irony prove nothing but a want of facts
and sound argument. They are quite unknown to science.

Hoping that our friend, Dr. Cartwright, will take this gentle rebuke
all in good part, we will now resume our subject.

Speaking of Dr. Hester's remarks, Dr. Cartwright observes, that Dr.
Hester " had not heard, when he wrote them, of the experiment with
the battle-ground crocodile, on the 18th of June, and did not know that
la grande dragonne, on that occasion, had thrown the renowned knight,
Dr. B. Dowler, from the saddle, and that he and his whole command
were in captivity." By these words it is evident that Dr. Cartwright
intends to convey the idea, that the experiments of the 18th of last June
were completely successful, and had prostrated all his opponents. Now,
nothing is farther from the truth than this, if we may believe credible
eye-witnesses of those experiments. Those experiments were a perfect
failure; and went directly against Dr. Cartwright. We have conver-
sed with Dr. B. Dowler several times on the subject, and have also ex-
amined the copious notes which he made immediately after the experi-
ments were closed. The experiments, too, were made by Dr. Dow-
ler's own hands, and therefore we must give credence to his statements.
The facts were these : Dr. Cartwright, having seen the alligator of the
6th of May come to life with a ligature about its trachea, contrary to
his views, resolved to make another experiment, for the purpose of
showing how he could kill an alligator by ligation of the trachea, and

350 The New -Orleans Medical and Surgical Journal*

then bring it to life again by insufflation, thus establishing, as he sup-
posed, Mrs. Willard's theory. Accordingly, on the appointed day, he
invited to witness the experiments some fifteen gentlemen, including, as
he states in a letter to myself, " a sprinkling of preachers." The tra-
chea being tied, the animal appeared to die very soon, as in the case
of the 6th of May. The next thing was to bring it to life by insuffla-
tion, but in this the failure was complete. Dr. Cartwright was greatly
mortified, and many of his friends present regretted exceedingly the fail-
ure on his account.

In his article of the 25th of August, in the Boston Medical Journal,
Dr. Cartwright seems to labor to conceal the fact, that the restoration
of the animal by insufflation was a principal object of the experiment,
and speaks as though he did not expect confidently that result himself.
We are credibly informed that he did. He ascribes the failure to the
lungs having been cut into and lacerated. Dr. Dowler, who performed
the dissections on the occasion, declares that the lungs were not cut —
that they were entire when the inflation commenced, and that they were
lacerated by the violence of the insufflation only. But even admitting
that the lungs were cut open, this ought not to have defeated the resto-
ration, according to Dr. Cartwright's own statements, in relating the
previous experiment of the 6th of May. In that experiment he says
the animal came to life because the lungs were cut open ! His words
are these : uThe trachea was then untied and an attempt made to in-
flate the lungs, when the cause of its resuscitation was discovered ; in
opening the thorax the lungs had been pierced in two places. * *
These vents served, no doubt, to give vent to the poisonous carbonic
acid retained in the lungs when the trachea was tied. When the lungs
were cut into, the carbonic acid escaping had the same effect in restor-
ing animation, as if it had been removed by artificial respiration."*
The lungs, however, were not cut, as we are informed.

According to the above, the cutting of the lungs, in the 18th of June
experiment, ought to have aided restoration ; and thus is the explanation
given by Dr. Cartwright of the failure on the 18th of June, shown to be
incorrect, or at. least inconsistent with his own words.

Nor was the experiment of the 18th of June by any means conclu-
sive as to the question, whether ligation of the trachea will or will not
kill the alligator ; for to decide that question the experiment was not

* Boston Med. and Surg. Jour., June 16, 1852.

Dr. Ely on the Motive Power of the Blood. 351

properly made. The animal was all " cut to pieces" in less than an
hour after the trachea was tied, and therefore could not be expected to
revive. The only correct way of settling the question would be, to
simply tie the trachea and then leave the animal in his den for a day or
more. We do not, however, attach any importance to the question, as
regards its bearing upon Mrs. Willard's theory. Admitting that the
ligation of the trachea will speedily kill the alligator, that fact would
merely prove that the animal, like all others, cannot live without air ;
and not, as Dr. Cartwright supposes, that air inhaled into the lungs
causes the blood to circulate.

In regard to the case of the child, restored by artificial respiration,
we need not add any thing more, as we have given a full account and
explanation of the case in the last number of the New Orleans Medical
and Surgical Journal. Dr. Cartwright, however, claims a complete
victory for his imaginary agent, " haematokinety," on the strength of
that case ; but he forgets to show how the case proves his theory.
Mere assertion will not do. He also claims a victory for " haemato-
kinety," from the microscopic observations of Prof. Riddell ; but does
not even attempt to show how those observations prove his theory. Dr.
Cartwright five times, in his strange article in the last New Orleans
Medical Journal, triumphantly asks, " What is haematokinety ?" We
can easily answer this question : Haematokinety (cu/jloc. et xivsw) is an
imaginary creation of Dr. Cartwright's brain, so far as all facts, as yet
adduced, prove any thing. We do not wish to be severe upon Dr. Cart-
wright, but it is now time to deal with facts. It avails nothing to Dr.
Cartwright to deal in broad assertions, so long as he does not accom-
pany them with the demonstrative, or at least corroborative facts. I
am ready at any time to declare myself a convert to "Haematokinety,"
whenever Dr. Cartwright will produce the indisputable facts necessary
to establish that new principle.

Dr. Cartwright repeats his former assertion, that there are 12,000
species of fishes that have no left ventricle. " Although it is known to
naturalists," says he, " that of the 12,000 species of fishes not one has
any muscular organ answering to the left ventricle of animals, the able
professor so ingeniously worded his criticism as to lead the uninformed
to believe that something like a muscular organ, corresponding to the
left ventricle, actually exists in fishes to propel the arterial blood. He
took no pains to show that the bulbus arteriosus was on the right side,
and not on the left — a mere appendage of the right and only ventricle

352

The New-Orleans Medical and Surgical Journal.

fishes have got — and that there is no muscular organ at all to circulate
the red blood."*

How much truth there is contained in this short extract from Dr.
Cartwright, will be apparent to all on reading the following quotation
from Cuvier, the highest authority, as Dr. Cartwright admits. Speak-
ing of the circulation of the blood in fishes, Cuvier says : "The blood is
brought to the gills by the heart, which thus answers to the right ventri-
cle of warm-blooded animals ; and from the gills it is &ent to an arterial
trunk lying immediately upon the under side of the back-bone, which
trunk is the left or systemic ventricle of the heart, and sends the blood
throughout the body of the fish." Cuvier's Animal Kingdom, page 290,
London edition, 1840.

After this quotation from Cuvier, what becomes of Dr. Cartwright's
assertion, above, "that it is known to naturalists, that of the 12,000
species of fishes not one has any muscular organ answering to the left
ventricle of mamals V It was a mere assertion, unaccompanied with
any proof whatever. Will Dr. Cartwright tell us what naturalists deny
the truth of the above extract from Cuvier ?

It will be perceived, too, in the above extract which I have given
from Dr. Cartwright's article in the Boston Medical Journal, that he
indirectly accuses me of unfairness, in " so ingeniously wording my
criticism as to lead the uninformed to believe that something like a
muscular organ, corresponding to the left ventricle, actually exists in
fishes to propel the arterial blood." Now, all that I did was simply to
quote Cuvier, as above, a quotation which completely falsifies his bold
statement in regard to fishes, and which he answers only by bold, un-
supported assertion, and by intimating, very unkindly, that I had at-
tempted to mislead " the uninformed." Assuredly this is a very sin-
gular way of invalidating the statements of Cuvier and his commenta-
tors; for it is to be recollected that the London edition of 1840, quoted
above, was published by a corps of distinguished savans and natural-
ists, who all subscribe to the above quotation. As to the unkind inti-
mation in regard to myself, I pass it over without comment.

Dr. Cartwright again alludes to the subject of lymphatic hearts. I
have examined the Anatomic Comparee of Cuvier, and find that Dr.
Cartwright quotes Cuvier correctly ; but the existence of lymphatic
hearts proves nothing in favor of Mrs. Willard's theory, which declares
the circulation of the blood to be independent of hearts.

* Boston Med. and Surg. Jour. Aug. 25, 1852, p. 81.

Dr. Ely on the Motive Power of the Blood.

353

Dr. Cart wright, in his article of the 25th of August last, in the Bos-
ton Medical and Surgical Journal, resumes the subject of the circulation
in insects, and labors to prove that they have no heart, and that their
circulation depends entirely upon " haematokinety." He does not ad-
mit that the dorsal vessel is a heart; but he cites no authorities whatever
in support of his statements. He says : "Because the early entomologists
happened to call the dorsal vessel a heart, and observed a flux and re-
flux of the fluids contained in it," etc., etc. ; as if none but the early
entomologists called it such; when, in fact, all of the most noted entom-
ologists of the present day call it a heart. Dr. T. W. Harris of Cam-
bridge, in his Report, in 1841, on the Insects of Massachusetts, pub-
lished by order of the Legislature of that State, says : " The heart (of
insects) is a long tube, lying under the skin of the back, having little
holes on each side for the admission of the juices of the body, which are
prevented from escaping again by valves formed to close the holes
within. Moreover, this tubular heart is divided into several chambers
by transverse, partitions, in each of which there is a hole shut by a
valve, which allows the blood to flow only from the hinder to the fore
part of the heart, and prevents it from passing in the contrary direction.
The blood, which is a colorless or yellowish fluid, does not circulate
in proper arteries and veins, but is driven from the fore part of the heart
into the head, and thence escapes into the body, where it is mingled
with the nutritive juices that filter through the sides of the intestines,
and the mingled fluid penetrates the crevices among the flesh and other
internal parts, flowing along the sides of the air tubes, [Dr. Cartwhight
says the blood cannot go to seek the air,] whereby it receives from the
air that influence which renders it fitted to nourish the frame and
maintain life."

The latest French authorities also declare the dorsal vessel a heart.
H. Milne Edwards and M. Deshayes say, in commenting on Lanarck:
" II est exact de dire que les insectes n'ont ni arteres ni veines ; mais
il parait indubitable que leur vaisseau dorsal n'est autre chose qu'une
espece de cceur tubiforme." Histoire Naturelle des Animaux sans Ver-
tebres. Paris, 1840.

The blood of insects circulates freely through all parts of the body,
and that, too, not by " haematokinety," but by the contractions of the
dorsal vessel. H. Milne Edwards cites M. DeBehn, in proof of this,
as follows : " Les contractions du vaisseau dorsal mettent ce fluid en
mouvement, et le dirigent vers la tete ; il revient vers Pextremite pos-
terieure du corps par les parties ventrales et laterales du corps, et ren-
tre dans le vaisseau dorsal par des ouvertures garnies de valvules.

354 The New Orleans Medical and Surgical Journal.

Quelquefois le mouvement circulatoire est vide par les battemens d'un
organe musculeux particulier situe a la base des pattes." Behn, Ann. des
Scien. Nat. 2e serie, t. 4, p. 5.

There is nothing of "haematokinety" in all this. M. Milne Edwards
also cites Wagner, Burmeister, Duges, and the Memoires de PAcade-
mie de Bonn, as saying that " Le liquide nourricier des insectes, que
merite a tous egards le nom de sang, n'est pas en repos comme on
le croyait generalement, mais circule dans un systeme de lacunes. Le
vaisseau dorsal parait en etre le principal agent moteur, mais quelque-
fois il existe aussi des organes accessaires destines a les usages anal-
ogues. Ainsi, il y a dans la base pattes des Notonectes unappareil
valvulaire dont les battements contribuent a imprimer au sang le
mouvement dont il est anime.

M. Strauss also says : " Le sang recu dans l'interieur du vaisseau
dorsal est, par consequent, pousse vers la tete par les contractions de cet
organe. L'extremite anterieure du vaisseau dorsal est tres grele, et
quelquefois se divise en deux, en trois, ou meme en un plus grand nom-
bre de branches qui sont ouvertes au bout, et qui laissent echapper le
sang dans les lacunes, situees entre les visceres, les muscles et les te-
gumens."

After reading the above extracts from some of the most eminent na-
turalists, one will smile at the statement of Dr. Cartwright, that " the
early entomologists happened to call the dorsal vessel a heart ;" and
one will also be at a loss to conceive how insects, having such a circu-
latory system as that described by the above entomologists, could owe
the circulation of their blood to that ridiculous figment of Dr. Cart-
wright's brain, " haematokinety." It is a remarkable fact, that insects
have a more extensive contractile apparatus, in proportion to their size,
for propelling their blood through the tissues, than any other order of
animals.

Dr. Cartwright declares that I "would make my verbal logic exclude
the evidence of three millions of species of animals proving the truth of
the doctrine that it is the air which gives life and motion to the blood."*
To this I have simply to say, that I have endeavored to prove nothing
by mere verbal logic, to exclude nothing, to introduce nothing. Those
who have done me the honor to read my articles in the September and
July numbers of the New Orleans Medical and Surgical Journal, 1852»
will readily say that there is nothing in them depending on mere verbal
logic. I have dealt only with facts and logical arguments ; and I only

* Boston Med. and Surg. Jour. Aug. 25, 1852, p. 81.

Dr. Ely on the Motive Power of the Blood. 355

regret to say, that my able and learned opponent has only met my facts

with assertions, unaccompanied by proofs, or the citation of respectable

authorities ; and my arguments with ridicule, irony and uncourteous in-

timations. I am disposed, however, to be lenient, knowing my able

opponent inclined to be humorous ; but I must insist, in future, on a

more grave and dignified mode of scientific discussion. I am not, how-

ever, entirely opposed to the question of the Roman poet :

•• ridentum dicere verum
Quid vetat ?

but the dignity of science requires that we should adopt, in general,
as our motto : "Amoto quaramus seria ludo."

Dr. Cartwright wields an able pen, and we trust that he will continue
his physiological researches. We are happy to see, by his articles in
the Boston Medical and Surgical Journal, that he lends his support to
the brilliant physiological developments of our distinguished fellow-citi-
zen, Dr. Bennet Dowler, whose researches in physiology have widely
extended his name, and ranked him among the first of American phy-
siologists.

|p art Second.

EXCERPT A.

I. — On the effect of Colchicum in Dropsy.

BY DR. MACLAGAN.

In dropsy succeeding to scarlatina, I have frequently found colchicum of
much service, especially in cases where the urine is much suppressed, and
where comatose symptoms are present. The accession of coma may easily
be ascribed to the accumulation of urea in the blood ; and the power which it
has been shown that colchicum possesses of replacing the urea in natural, and
often superabundant, amount in the urine, seems to point it out as a useful re-
medy in this and other diseases in which suppression of urine and coma co-
exist. In a case of scarlatina which I attended along with my friend Dr. A.
Christison, now of the H. E. I. C. Service, and where the urine was totally
suppressed, and the symptoms of coma were present, the acetic extract of col-
chicum was used with complete success. Diluents and ordinary diuretics were
freely employed when the case was first seen, with the effect of causing a
slight secretion of urine of low specific gravity. Having suggested that- col-
chicum might be found of some service, and being anxious to observe its effects,
both as a diuretic and an eliminator of urea, I examined the urine before its
exhibition. The result was as follows —

Urine examined on the 10th of April.

The acetic extract of colchicum was ordered on the 11th April, and the
other medicines discontinued. On the 12th the comatose symptoms were con-
siderably abated ; urine of a normal density was passed in tolerable quantity,
and was examined again on the 13th, two days after the exhibition of colchi-
cum. It contained —

Total solids,
Urea,
Uric acid,
Inorganic salts,
Organic matter and water,
Albumen,

2.427
a trace
13.510
969.573
14.490

35.795

Total.

1000.000

Excerpta. 357

Total solids, .... 30.759

Urea, - 7.500

Uric acid, - - - 0.480

Inorganic salts, - - 8.71 8

Organic matter and water, - 975.359

Albumen, - - - 7.943

Total, - - 1000.000

On the evening of the 14th the comatose symptoms disappeared ; urine of
normal density was passed in proper quantity ; the dropsical effusion and ana-
sarca completely gone. On the 15th considerable diarrhoea had set in ; the
colchicum was stopped, and the urine again examined. It contained —

Total solids, .... 27.972

Urea, - 13.573
Uric acid, - - - 0.814

Inorganic salts, - - 7.431

Organic matter and water, - 978.182

Total, - - 1000.000

The analysis of the urine in this case will show the powerful influence
which colchicum possesses in altering the renal secretion, and of how much
service, as a remedy, it may be in cases of threatened poisoning by urea in
the blood. I believe, in all cases where albumen and urea appear to be vicari-
ous, and where coma supervenes, evidently from the accumulation of the lat-
ter principle in the blood, that colchicum will prove to others of as great service
as it has already done in the small experience I have had of it.

Two other cases of a similar nature, in which the urine was examined at
regular intervals, were treated in the same manner as that which I have re-
lated, with precisely the same result.

(Monthly Jour. Med. Science, Jan. 1852.)

II. — On the Claims of Homccopathy.
In an address delivered before the Medical Association of Southern Central
New York, the President, Dr. James H. Jerome, used the following language.

(Ed.)

Of this system of medicine I scarcely know how to treat, and should pass it
in silence, were it not enumerated in the list of competitors for public confi-
dence and favor. For as readily would I enlist in a campaign with ball and
bayonet, against an army of fairies, as to attempt by rational induction to over-
throw the foundations of this fanciful system.

The construction of mind necessary to its embrace forbids all rational hope
of successful attack. The first state of which is a distrust of all scientific
and rational induction in medicine. The second, that the professors of medi-
cine who base themselves on this platform, are but a band of pirates, to be
met and baffled, no matter how. With these convictions unmistakable and
abiding, he or she is permitted to leave the anxious seat and by the simple act
of faith in the great god Hahnemann, and Jahras his prophet, are entitled to a
place in the temple of his saints, as patient or professor.

With these qualifications, the avenues of successful approach to the unbi-

353

The New-Orleans Medical and Surgical Journal.

assed mind and reason of the devotees of this popular delusion, are utterly and
hopelessly closed to the unconditionally proscribed.

Were you, gentlemen, to open a Homoeopathic Pharmacopia where the man-
ner of preparing the medicine, and the quantity to be used is most minutely
and with great apparent sincerity described, and read therefrom this conclusion
of the author, after having treated of the manner of procuring an ultimate dilu-
tion, apparently conscious of the drought which would naturally follow its com-
pletion in a dry region, that " true, an ordinary lake would fail to furnish a
sufficient quantity of water to reduce one drop of the mother tincture to its ul-
timate dilution. Yet a homoeopathic preparation could never be made of a
lake, in consequence of our complete inability to give it the requisite number
of snakes."

I fancy, gentlemen, your arithmetics would be at fault to determine the ex-
act amount due to each of the dozen or more pellets to be saturated with one
drop of this ultimate dilution, but away with your mode of reasoning and calcu-
lation, and learn irom further consultation with the author, that the effect pro-
duced depends not upon the quantity used, but rather upon the quantity not
used — for he will gravely tell you that the potency of his medicine will conti-
nue to increase in direct ratio with the extent of the dilution — ad infinitum.
What mode of reasoning, think you, would convince such a mind that medicine,
the result of such process, was no longer medicine, that it was wholly incapa-
ble of producing a medicinal effect? No matter what, the invariable reply is
ready in the quotation of a thousand and one cases of most brilliant results fol-
lowing its administration. Such an one was attacked with severe pain in the
stomach, (after dinner, perhaps) turned to his book, found the pain described,
with its antidote ; opened his case of vials ; secured the pellet ; placed it upon
the end of his tongue, and the pain was instantly relieved. Another, a child,
was attacked with croup, that horror of the nursery, the symptoms examined,
medicine ascertained, and a cork from the thirtieth dilution of the right sort
placed under its nose, a sniff taken, and the child sneezed, and ere the cork
could be replaced, the little sufferer was in the midst of its amusements, with
respiration as free and as unruffled as ever.

If not satisfied with these quotations, you are instantly plied with the long
list of adherents, Reverends, Esquires, Aristocrats, and the fastidious of every
hue. And the mind that for the sake of truth, of reason, and correct rational
inquiry in medicine, that can resist all these, is given over of Homoeopathy to
blind and hopeless incredulity.

Much credit, however, is due to the founders of this system, for the rich
displays of the power and genius of the human mind. From the infinite va-
riety of pains discovered and described, we are to conclude that the sentient
extremity of every nerve has been consulted, and the sensations peculiar to
each not only noted, but rendered with such clearness and perspicuity as to
be within the comprehension of the most common observer.

In the arrangement of medicine, again, the provision appears to be nicely
adapted to the demand, consequently the system is complete. Medicine suited
to the pain, and pain suited to the medicine. Whether the system of medicine
was first arranged, and the symptoms subsequently adapted to the medicine, or
vice versa, does not appear. Yet there is peculiar prominence in the fact, that
there is a pellet for every pain — ergo, a pain for every pellet. This question
of priority, however, we suppose to be matter of indifference with the thor-
oughly indoctrinated. We may not then attempt, by our mode of reasoning,
to controvert the claims which this system has to confidence and favor. But
with becoming resignation await its day of doom.

Excerpla*

359

III.— On Pathological Cell Development.

Dr. Gairdner made a verbal communication of considerable length on certain
peculiarities of pathological and other structures, as bearing on the different
theories of cell development, He considered the cell theory of Schleiden and
Schwann, although it led to the discovery of many interesting facts, and really
important morphological generalizations, to have been utterly overthrown, as a
general theory of development, by the progress of scientific inquiry. The cell
of these physiologists, so far from having the fixed and uniform character of a
basic type of form, was the most fluctuating and uncertain of all morphologi-
cal creations. Its form, size, law of development, were either confessedly un-
certain, or had to be stated in terms so vague as to lead to the conclusion
that form and substance, and perhaps microscopic size, were the only attributes
essential to the idea of a cell. No one could tell, in practice, what was a cell
wall, and what was a nucleus, and no one could give a satisfactory theoretical
definition of either, or resolve, for all cases, which of the two preceded the
other in the course of development. The theory of." germinal centres," held
by Mr. Goodsir, in so far as it ascribed to certain " nucleated particles" the
function of the cell, was in Dr. Gairdner's opinion, subject, in like manner, to
the imputation either of vagueness or of want of comprehensiveness. If these
nucleated particles came under any more precise definition than was applica-
ble to every kind of organic or inorganic structural atom, it would be very dif-
ficult to show that they monopolized and centralized the whole functional acti-
vity of the organism, or were more necessary than other parts to its growth
and preservation.

He (Dr. Gairdner) believed that there was no distinction in the organism of
passive and active atoms, and considered every point and every molecule as
endowed with its own life, and placed, in its own peculiar sphere of activity,
in harmony with the rest. He agreed with Dr. Bennett in thinking, that many
tissues arose from elements far more minute than any to which the term cell
or nucleus had been applied ; indeed he was far from thinking that our micros-
copes had conducted us back to the real germs of the tissues, and considered
that the structural, like the chemical atom, still lay in the remote region of hy-
pothesis. He firmly believed, however, in these hypothetical germs, and could
not conceive of the tissues being formed by any thing like what the Epicure-
ans would have called a concourse of atoms, according to their physical and
chemical properties. Hence he did not think, that by the mere introduction
of peculiar molecular elements into the food, we could either create new tis*
sues or destroy old ones, so directly and simply as had been hinted by Dr. Ben-
nett.

The positive part of Dr. Gairdner's communication consisted in the detail of
observations on the structure and development of the pus-corpuscle and other
pathological structures, intended to show that the so-called cell walls were often
generated in great numbers, without, nuclei ; and that the whole of the facts of
cell development contradicted the idea of any part of a cell being, more than
another, the source of its functional development and activity. In regard to
the development of fibres, Dr. Gairdner thought there was no evidence that
these were ever produced from cells, under any circumstances ; and he had
long been in the habit of regarding the so-called fibre cells as merely transition
types in morphology, and not parts of a physiological succession of stages of
development. It was difficult to prove this view any more than its opposite,
but he thought any one who would give it consideration in original observa-
tions, would find it in harmony with all the known facts, both physiological
and pathological.

360 The New-Orleans Medical and Surgical Journal.

Dr. Sanders remarked that Kolliker had demonstrated unstripped muscular
texture to be composed of permanent fibre cells, whose development by elonga-
tion of spherical nucleated cellules he had traced in the pregnant uterus. This
texture, therefore, had been lately found a corroboration of Schwann's views,
which it was previously thought to contradict. Doubtless some textures were
formed without passing through the form of cells ; thus, particularly, fibrous
tissue, as observed in cartilage by Redfern andDonders; yet the constant pre-
sence of nuclei and cellules in skin, mucous membranes, glands, and bone,
their transition forms, their extensive devplopment in the foetus ; their occur-
rence in newly forming textures in all organized beings, animal and vegetable,
gave immense weight to Schleiden and Schwann's views, and justified our ad-
herence to them in physiological anatomy. In pathology their applications ap-
peared more limited, and less satisfactory.

Dr. Gairdner's statements, and a gaining distrust among observers at home
and abroad, proved the necessity of submitting the " cell theory" to the criti-
cism of new and extended observations ; it ought not, however, to be rejected
but only thoroughly reinvestigated.

{Canada Med. Jour.)

£V. — Of the Ferruginous preparations in Organic Affections of the Heart.

In affections of the heart, digitalis has been greatly abused. Recently many
writers on Pathology have condemned the free and indiscriminate use of this
article in organic diseases of this organ ; and now a course of treatment pre-
cisely opposite to that heretofore employed, is recommended on more rational
principles and a more enlightened pathology.

M. Alison has recently defined the indications which are to be fulfilled in
organic affections of the heart, characterized by dilatation of the ventricles- —
more particularly of the right ventricle. These indications are four in number?
as follows : The first is to overcome, or at least to weaken, as much as pos-
sible at its fountain, the resistance to the circulation — the cause of the dilata-
tion or hypertrophy; the second, to prevent the dilatation, or to diminish it when
it is produced ; the third, is to maintain the hypertrophy within certain limits ;
the fourth is to sustain and fortify the organ thus diseased and weakened. All
these indications, except the fourth, can only be fulfilled by the aid of to-
nics.

M. Alison demonstrated that hypertrophy of the heart is a happy contrivance
of nature ; that it augments the energy of this organ, and imparts to it suffi-
cient force to struggle against the obstacles which oppose the course of the
blood ; and that we commit a great mistake when we seek to destroy or paral«
yze these beneficent efforts of nature by the routine use of digitalis and other
powerful sedatives. The use of means of this kind is still more irrational in
cases of cardiac dilatation attended with attenuation or wasting of the walls of
the heart. Cardiac aneurism produces, besides, a state of general debility, and
imparts to the blood a diffluent character. Writers even go so far as to assert,
that impoverished blood may of itself become the cause of aneurism of the

Excerpta.

361

heart, because it is incapable of imparting a sufficient stimulus to its walls.
Besides, although the diffluence of the blood may be the cause or the effect of
the aneurism, it always plays the same part, namely, that of producing atony
of this organ.

Iron by restoring the constitution of the blood, imparts, by degrees, energy
to the contractions of the heart, and thus succeeds sometimes, as experience
has shown, in diminishing the existing dilatation. M. Alison reports, to sus-
tain his views, many facts, which cannot be here introduced for want of space.
The foregoing observations are of the utmost practical value, and should ever
be taken into consideration in treating the diseases of an organ so essential to
life. Heart-disease, so far as we have observed, is generally accompanied with
evidences of anaemia, either as cause or effect; and we have now under treat-
ment a case of cardiac affection in a youth about 16 years of age, evidently
associated with an impoverished state of the blood. Under the iodide of iron
his cardiac symptoms, if not improved, are at least stationary, — certainly his
general appearance justifies the continued use of the medicine.

(Ed. N. O. Med. Jour.)

V. — Iodine Clysters in the treatment of Dysentery.

BY DR. EIMER.

Dr. Eimer believes that the great point to which practitioners have to direct
their attention, is the enormous amount of organic losses consequent on the
continuance of this affection ; so that according to (Esterlen, within three
weeks, more than the entire blood-mass may pass away as albumen in the
stools. As a means of cutting these discharges short, he strongly recommends
iodine clysters, which, in recent cases, may at once arrest the progress of the
disease, and in all diminish the number of stools, and normalize their condition,
whatever the individual peculiarities of the case may be. From five to ten
grains of iodine, and as much iod. pot., are administered in two or three oun-
ces of water, from two to four times a day — twice daily usually sufficing. If
the rectum is too irritable to retain it, ten or fifteen drops of tr. opii are to be
added, and a mucilaginous vehicle substituted for water. Dr. Eimer employed
this remedy during an epidemic; and he believes the disease will, as a general
rule, be found curable by it, if it be resorted to before the organic changes in
the intestines have advanced too far, exhaustion becomes too considerable, or
more important complications set up.

In some slight cases it was employed alone. Generally a simple oily emul-
sion was at the same time administered, and sometimes acetate of lead and
opium.

(From Ilenle's Zeitschrift, in St. Louis Med, and Surg. Jour.)

302

The New-Orleans Medical and Surgical Journal

VI. — Influence of the Imagination or Will upon the Pregnant Woman.

BY I. G. BRAMAN, MASS.

The following somewhat unique case occurred in my practice, and is sub-
mitted for the pages of the Journal without note or comment.

In the month of May. 18—, I was summoned to attend Mrs. — , who

was at the close of the ninth month of pregnancy. As I entered the room, I
found every thing arranged for her accouchement, which was momentarily ex-
pected to occur. The pains were frequent and vigorous, and an examination
per vaginam revealed the os uteri fully dilated, the head advancing, and all
things as favorable for a speedy termination as could be desired. I consoled
myself with the idea that I should be soon^ released and on my way home. The
female assistants, those kind and sometimes convenient appendages to the lying-
in room, concurred most fully in this opinion, and were profuse in their encour-
agement and congratulations to my patient. But alas for the vanity of all early
expectations. She did not respond either in faith or by practice. On the con-
trary, she obstinately turned a deaf ear to all consolations, declaring, in em-
phatic terms, that " she should not be confined before aunt Nancy came back."
By the way, this same aunt Nancy was a woman of some considerable note in
that portion of the obstetric world, and Mr. had made a special arrange-
ment with her in reference to this occasion, but the miserable sinner regard-
less of her solemn promise, had left town on a visit. Her presence and sym-
pathy, it seemed, was a sine qua non, and consequently I must relinquish
every hope of accomplishing any thing while such an unfortunate conjunction
of circumstances obtained. In vain I laughed, expostulated and even scolded.

Mrs. ■ — made but one reply to all, " You may say and do what you please,

but I tell you I shall not be sick before aunt Nancy comes back, if she never
comes." The pains were still urgent, and a few expulsory efforts were all
that appeared necessary to complete the labor.

In this state of doubt and uncertainty we spent the night. Morning came,
but with it no relief. The major portion of the day was spent in the same man-
ner ; matters remained in statu quo. About 4 P. M. my assistants (who had
received some accession to their number from a neighboring domicil) began to
look grave, and exchanged significant glances. Suddenly they vanished, leav-
ing me solus with Mr. . By certain stifled whisperings, I inferred they

were holding a conference in an adjoining room. This, I knew, portended
some important communication to myself, and I waited with fortitude to hear
what it might be. I was not kept long in suspense. The door opened, and
marshalled in single file, they advanced, when the oldest, who had evidently
been chosen chief speaker, thus addressed me :

" Doctor, don't you think Mrs. ■ has been sick some time V*

" I do."

" Why is she not confined ?"

" You have heard what she says, and can judge as well as I."

" Is there any thing out of the way ?"

"No."

" Can't something be done to help her along ?"
"I know of nothing. We must wait patiently."
" Are you willing we should experiment upon her ?"
" It depends upon what it is.
" We won't do any thing to hurt her."

" Well, with such a condition you may try your experiment, but I shall in-
terfere if I see any thing in it calculated to do her harm."

With this consent they speedily commenced operations. A common wash

Excerpla.

363

tub was placed under a chair which had lost the whole or the greater part of
its bottom. Iu this tub some wormwood, hops, and I think tansy, were put, and
boiling water poured over them. After waiting a few moments for the water
to cool a little, Mrs. was taken from her bed, seated in the chair, duly-
propped up by pillows, and supported by the arms of all the feminine gender
present. This process was accompanied with various appropriate remarks,
such as, " There, now, we have fixed you nicely." " You will be sick right
off." " We aint a going to stay here again all night," etc. Contrary, however,
to their expectations, her pains immediately ceased. She was perfectly com-
fortable, and evidently enjoyed the change. The conclave stood aghast, and
after waiting over an hour, gave up their experiment, and with much chagrin
replaced the good woman upon her bed.

There she remained one fortnight, happy and contented, suffering no annoy-
ance, except some slight derangement of the stomach, which was easily re-
lieved by appropriate remedies. At the expiration of this period aunt Nancy

fortunately came back. No sooner did Mrs. hear of this than her pains

returned. Aunt Nancy was sent lor, I was again summoned, and in a very
short space of time a fine girl made its debut into the world.

June 9th5 1852.

(St. Louis Med. and Surg. Jour.)

VII. — Syphilis.

The subject of syphilis has been so fully reported on in a former volume,
that it will not be necessary on the present occasion to do more than allude to
the most recent communications.

A very important and useful contribution to the literature of syphilitic dis-
ease by Mr. Erasmus Wilson, is the latest monograph which has appeared on
the subject. The intention of the work, as we gather from the preface, is to
define and distinguish, more accurately than had previously been done, the sy-
philitic eruptions of the skin from those of simple origin. One of the first re-
sults of this investigation, the author informs us, " is the discovery that there
is but one syphilitic eruption, and that the apparent differences in the charac-
ter of the cutaneous affection are the simple consequences of modification in
the development of that eruption, depending on time, treatment and tempera-
ment of the patient."

Another result of the author's inquiries is, that there is but one syphilitic
poison, which may show itself in an ulcer, or in gonorrhoea, and that the latter
is as certainly followed by secondary symptoms as the former.

The induration of the Hunterian chancre is also further believed to be the
result of constitutional action, and likewise the evidence of systemic conta-
mination.

On the subject of constitutional syphilis, the author holds opinions in many
respects at variance with generally received doctrines. He believes that once
admitted it is rarely eradicated, and that it will show itself even after succes-
sive generations. Scrofula is regarded as syphiltic ; so are phthisis, lupus,
lepra, and psoriasis. Lastly, the author holds, in its fullest extent, the com-
municability of the constitutional disease, through the medium of the secre-
tions.

In giving a rapid analysis of the volume we may state that chapter I. gives
a description of the modes in which the disease is transmitted, and in which
the author insists strongly on the communicability of the constitutional dis-
ease, and illustrates the facts by several cases.

364

The New -Orleans Medical and Surgical Journal.

Chapter II. gives a brief account of the primary manifestations of the dis-
ease. Chapter III., of the secondary or constitutional ; after which, in chap-
ter IV., the author proceeds to the classification of the syphilo-dermata or va-
rious forms of evolution of the syphilitic poison by the skin, all of which he re-
gards as an attempt, on the part of nature, to eliminate the poison from the
blood. The first of these mentioned is simple congestion, forming syphilitic
roseola, which is further subdivided into R. versicolor, orbicularis, annulata,
punctata, and papulata. The latter is the link between the non-elevated and
elevated eruptions.

The next degree is lichen, which has five varieties — corymbosus, dissemina-
ta, confertns, annulatus, and pustulosus.

The third degree is the syphilitic tubercle, which the author also divides
into five groups — corymbosa, circumscripta, disseminata, annulata and ulce-
rantia. All these varieties are minutely described and illustrated by three ad-
mirably executed colored lithographs.

Chap. V. is occupied with some other syphilitic phenomena not previously
mentioned, such as alopecia, erythema, palmare, condylomata ; also its lo-
cal actions on mucous membranes in the nervous system and in the perios-
teum.

Chapters VI. and VII,, congenital syphilis. " In this chapter the author de-
velops his peculiar views respecting the identity of scrofula and syphilis, as
well as of the syphilitic origin of lupus, etc.

We now come to the treatment of syphilis, which occupies the eighth and
concluding chapter. The author first speaks of the prophylactic treatment ;
which consists chiefly in rigid attention to cleanliness after intercourse. If
excoriation occurs, he advises slight cauterisation, with argentum nitras.
The abortive treatment is next considered. As soon as any indication of chan-
cre appears, the author advises cauterisation at once, with potassa fusa
or potassa cum cretae. The nitrate of silver he considers to be perfectly in-
efficient.

The curative treatment is made to consist in two indications : 1, to prevent
the increase of the poisonous ferment in the blood ; 2, to ensure its removal by
the natural emunctories.

The first indication is fulfilled chiefly by hygienic measures, as diet, exercise,
bathing, etc.; the second by certain medicinal agents. Of these the principal
is mercury. The preparation of this drug preferred by the author is blue pill,
in doses from two to five grains, combined with a sedative. In addition to this,
sudorifics are valuable adjuncts.

" In a word, observes the author, " the treatment of primary syphilis con-
sists in limiting supply, and encouraging waste. But the supplies are to be
limited, not restricted ; the waste is to be encouraged, not allowed to run to
profusion."

The author specially insists upon the great importance of avoiding sali-
vation.

In the treatment of constitutional syphilis, Mr. Wilson relies upon the binio-
dide of mercury, in doses of one third of a grain three times a day, in the first
instance ; but in the more chronic forms, or tertiary phenomena of Ricord,
mercury is said by him not only to be useless, but injurious. It is now that
the use of the iodide of potassium is attended with such satisfactory re-
sults.

Mr. Wilson concludes with the treatment of lupus, which, as he regards the
disease as syphilitic, he conducts on the ordinary principles of syphilitic medi-
cation. A remarkable case is detailed, in which this method was eminently
successful.

(Rankin's Half Yearly Ab. Med. Scien.)

Excerpta.

365

VIIL— Treatment of Obstinate Ulcers by the internal use of Tincture of Can-
tharides.

BY J. TART, ESQ.

In a case of extensive ulceration in a broken constitution, after the failure of
various plans of treatment, Mr. Tart gave ten drops of the tincture of cantha-
rides three times a day, with marked benefit. In three days from the com-
mencement the sores began to contract, healthy lymph appeared round the ed-
ges, and vivid granulations started up. In a fortnight the ulcers were healed.
On this case the author remarks :

" Such was the progress and issue of a case that had baffled every previous
treatment employed. It affords one of many examples I could bring forward
of the great utility of cantharides in indolent ulceration, dependent either on
atony of the engaged parts, or system generally.

In 1845, while resident in Burmah, my attention was directed to the treat-
ment of the ulcers met with in that country, and which had long been found
difficult to heal by different medical gentlemen stationed upon that coast. I
drew up a paper, exhibiting the appearances presented by the different ulcers,
and the states of constitutional derangement with which they were identified,
and in which I had employed the tincture of cantharides with marked success.
The paper alluded to, backed by several cases treated by different medical
friends, was forwarded to the Madras Medical Board, who ordered it to be cir-
culated throughout the medical service of the Madras army.

A few extracts from the paper here referred to will show the character of the
ulcers where I found the tincture of cantharides useful :

1st. Where the granulations were exuberant, but pale, weak and flabby.

2d. Where there was deficiency or total abstinence of granulations, the
ulcers being deep and scooped out, with raised and indurated edges.

3d. Where the granulations were not defective, but cicatrizing irregularly,
sometimes in the centre,at other times on one side,the lymph which was thrown
out and organized one day being absorbed the next."

(Ibid.)

IX. — On Catarrhal and Lobular Pneumonia in Infants.

BY M. TROUSSEAU.

The eminent physicians who have written upon acute diseases of the chest
in children, have clearly pointed out the symptoms, the lesions, and the relative
gravity of the inflammations known under the names of lobular pneumonia,
capillary catarrh, catarrhal pneumonia, pneumonic catarrh, and simple acute
pneumonia. As, however, these accurate notions are scattered throughout
voluminous treatises, or contained in detached and little known essays, the
generality of practitioners entertain erroneous notions of the diseases of which
we have spoken.

Catarrhal and true pneumonia (la pneumonia franche) are in truth as differ-
ent one from the other, as are variola and erythema. We may adduce proof
of this from the difference in their mortality. Of twenty children admitted du-
ring six months, suffering under acute true pneumonia, not one had died; whilst

366 The New -Orleans Medical and Surgical Journal.

of 36 children attacked with catarrhal pneumonia, not one had survived. Such
diversity in the demonstrated results places these two diseases at an immeas-
urable distance from each other.

We may state, in order to give this parallel a more striking character, that
in true pneumonia the symptoms exhibit an excessive activity and acuteness,
and then suddenly subside. On the contrary, a certain proportion of cases of
catarrhal pneumonia, however mild they may appear at the outset, rapidly as-
sume an uncontrollable severity.

We have elsewhere, and that frequently, traced the groups of symptoms
which characterize these two forms of disease, nevertheless we again present
a summary thereof.

True pneumonia scarcely ever attacks an infant under two years of age; very
rarely does it occur to those between two or three years of age; and it is met
with more frequently as the child approaches youth. It has the same charac-
ters, signs and symptoms, as those of acute pneumonia in the adult, as we
shall show. After twenty-four or thirty-six hours existence, the signs of the
disease are but little heard, above the breathing sound and bronchophony, ex-
cept by a crepitant rale, which in the adult is more frequently audible during
the act of coughing, while the tubular breathing is heard over a considerable
extent, the crepitant rale is seldom heard in infants. There remains in these
cases from day to day, when the tubular sound has disappeared, merely a feeble
respiratory murmur.

The course of the disease is also much more rapid, at least in children
between three and eight years of age, after which period pneumonia differs
less and less from that of the adult. The result proves that this is not a very
fatal disease ; however unskilful the physician may be, he will cure the greater
part of his cases, if the attack be slight ; however skilful he may be, he will
lose an uncertain number, when the disease is of a severe character. Chil-
dren are often brought to the hospital in the fourth, fifth or sixth days of the
disease, and convalescence commences almost immediately. It cannot be
supposed that the medical means (sufficiently trifling very often) employed could
have had a notable influence upon the disease. Those who are admitted at the
onset of the disease are so speedily cured, that we are often disposed to attri-
bute to remedies effects which depend upon the natural mildness of a disease,
which, under other circumstances, is attended with a formidable array of
symptoms.

We ordinarily perform a venesection from the arm to the amount of from
sixty to a hundred and twenty grammes (equal to 15 and 30 drachms, English)
we excite vomiting by a mixture containing from thirty to forty centigram-
mes (equal to from four to six grains, English) of sulphate of copper, in fifty
grammes (equal to about one and a half ounces, English) of some simple fluid.
Thus, medicine is given once or twice a day during the most acute period of
the disease. We then administer a linctus containing from ten to fifteen
centigrammes (equal to about one or two grains, English,) of Kermes'
sulphuret of antimony, and the same quantity of the extract of digitalis (?).
These remedies are discontinued as soon as the pneumonic respiration dis-
appears.

Catarrhal pneumonia does not manifest itself under the same aspect. It
begins with catarrh, which rapidly extends to the small bronchi, invading in
detached parts both lungs, especially behind ; the crepitant rales are numerous
and fine. These stethoscopic signs are observed for four, six, eight, or fifteen
days, without the respiratory murmur being audible. Sooner or later, how-
ever, the murmur is heard, when either the cry or the voice is restrained, or
at least the breathing sounds are prolonged. While the signs which are com-
#mon to catarrhal and to pure pneumonia are manifest in one part, the per-

Excerpta.

307

sistence of catarrhal pneumonia in another portion of the lung may be known
by the persistence of the subcrepitant rale. It seems evident that the disease
which had commenced in the mucous membrane, has extended to the parenchy-
ma of the lung.

Although the febrile symptoms are less violent than in true pneumonia, they
manifest considerable severity at certain hours in the day, subsiding almost
entirely at other times; presenting the changes from better to worse, alter-
nately elevating and depressing hope, and this state lasting for fifteen, twenty,
or thirty days. Thus it exhibits the obstinate and uncertain feature of catarrh.
The points of lesion become multiplied as the disease spreads to different parts;
the fever acquires greater severity, the embarrassment of breathing is aug-
mented, and the poor little sufferers sink exhausted, whilst some die more rap-
idly when the disease has greater severity from the outset, and the lungs have
been quickly invaded over a large extent ; bleeding, revulsives, antimonials,
emetics, belladonna, squills, digitalis, polygala, having been tried without ben-
efit.

The disease has generally a speedily fatal termination when it follows upon
measles, an affection of the skin, or acute laryngitis.

These two diseases may, exceptis excipiendis, be compared in some of their
features to the resemblances between erysipelas and phlegmon; erysipelas, like
catarrh, passing over the surface, and when it has continued some time, pro-
ducing ulcerations of the skin, boils and abscesses, in the same manner that
capillary catarrh produces purulent deposits in the structure of the lungs ;
while pure pneumonia proceeds rather in the manner of simple phlegmon,
severe in its inflammatory accompaniments, but terminating quickly and en-
tirely.

An apology may appear necessary for our having thus dilated upon so ordi-
nary a topic as that of infantile pneumonia, but more than one physician who
has only studied diseases of the chest in hospitals for adults, will perhaps find,
in what has now been said, the explanation of facts which have perplexed him.
He will understand why the severity of pneumonia differs so widely in children,
and when he shall be able to distinguish catarrhal from true pneumonia, he
will be enabled to give a more confident prognosis.

We do not, however, wish it to be supposed that we consider catarrhal
pneumonia as invariably fatal. If it be so in hospitals, where impure air exerts
a prejudicial influence, it is not the case in private practice. Here the benefi-
cial effects of frequently repeated emetics, of vesicatories, of antimonials, digi-
talis, etc., cure at least half of the cases; but at the same time a large proportion
proves fatal, for the mortality of that disease is certainly fearfully great, in
which one half of the cases end fatally.

(Archives Gen. — In Half Yearly Abs.)

X. — Cholera and Dysentery.

Since the issue of our last number the Cholera has continued to prevail, to
a limited extent, in Columbus, and in a few of the towns in its vicinity. As our
city authorities did not think proper to organize a board of health, nor appoint
persons to ascertain the extent of the disease among us the present summer,
we are unable to give an accurate statistical account of its mortality. We
believe that about fifty or sixty persons have died of Cholera since the 25th of
June last. The disease, when fully developed, manifested its usual malignity,

368

The New-Orleans Medical and Surgical Journal.

and with few exceptions, proved fatal ; but there were a great number of cases
bearing the symptoms of incipient cholera, which yielded directly or kindly to
opium, calomel, camphor and aromatics, with rubefacient counter irritation.
How many of these would become, without treatment, confirmed cholera, we
believe observation will not enable us to determine.

In the early stage of this fearful malady, there is perhaps little doubt as to
the efficiency of the remedies adverted to. If there is value in experience, we
cannot avoid the conclusion that opium will allay the irritation of the stomach
and moderate the peristaltic action of the bowels ; that mercurials will excite
a flow of bile and render the alimentary evacuations more consistent; that
camphor and aromatics will quiet nausea and give tone to the stomach, and
that rubefacients will act as salutary revulsives. They will produce these
desirable results, provided always that the organs to which these remedies are
addressed have not lost their impressibility to such stimuli. But there are
very strong doubts in our minds, at least as to their remedial powers, in fully
developed cholera. That such cases do occasionally recover, every physician
of experience will affirm. Some under one plan of treatment, and some under
another, while others, and perhaps an equal number, recover in the absence of
all treatment, or what is equivalent to it, homoeopathic treatment! Several
cases have come under our own observation, which have laid for days in a
partially collapsed state, with frequent discharges, and at the same time they
were taking sugar pellets medicated with infinitesimal doses of nothing ; and
strange to say they recovered, as every man in his senses knows, without me-
dicine.

The former class of patients recovered uninfluenced by the most potent
remedies ; the latter class recover entirely without them ; while each class of
champions of the healing art boast, but not according to knowledge, of the
trophies of their skill, and the transcendental excellencies of their plan of
treatment. Truly there are fallacies in medicine as well as in the other pro-
fessions, and the wisest are liable to be deceived by the ever varying circum-
stances by which cases of the same kind are surrounded.

The cholera has not altogether left our borders ; but

The Dysentery has perhaps been unusually prevalent among us during the
present summer. As on former occasions, the latter disease has accompanied
and followed the former. Indeed all " bowel complaints" have been rife, and
few have entirely escaped a disordered condition of the alimentary canal. Ty-
phoid fever has made its appearance, but usually in a sporadic form. Inter-
mittent fever has not transcended its ordinary prevalence at this season of the
year. The disparity between the prevalence of dysentery and intermittent
fever would, we should suppose, be a matter of surprise to those who believe
that both these diseases arise from the same malarious origin, and conse-
quently should be treated with the same anti-periodic quinine. This notiony
we are convinced, is a mischievous one, as will be seen presently.

Several physicians have applied to us by letter, for our views as to the most
appropriate treatment of dysentery. We can readily imagine how a few par-
tial friends might be desirous of obtaining them from our own hand ; but we
have not the vanity to suppose that our notions as to the treatment of this dis-
ease would attract the slightest attention from the profession at large. First,
because we have nothing new to offer ; and second, because if we had, our
professional reputation is not sufficient to enforce the trial of our suggestions
to any considerable extent. Nevertheless, it may be our duty, and it certainly
affords us pleasure to give our testimony in regard to — we had almost said, the
omnipotence of opium as a sheet anchor to the treatment of this most distress-
ing malady. This remedy must ever be the main reliance, and so far as this
disease is concerned, it is the blessed boon from God to man I Without it, the
agonies of death are unequal to the tortures of violent dysentery. With it?

Excerpta.

369

the indescribable pains are alleviated, and the patient falls at once into com-
parative ease and rest.

But opium is not the only remedy in dysentery. We have unshaken confi-
dence in the use of occasional doses of saline purgatives. Epsom salts to the
adult, and Rochelle salts to those of tender age. These purgatives we admin-
ister every third or fourth day. They act in a salutary manner in several
ways —

1st. They irritate the bowels less than almost any other cathartic medi-
cine.

2d. They sweep out the alimentary canal as thoroughly as any other.

3d. They produce, for the time being at least, nearly natural bilious evac-
uations, and sometimes the dysenteric discharges never return after their ope-
ration.

4th. They>seem, by their hydragogue powers, to disgorge the capillary ves-
sels of the mucous membrane of the lower bowels, vby which they are enabled
to contract upon themselves, and to resume thereby more nearly their normal
calibre. The last idea is purely theoretical, and must be so, as we have no
means of verifying their effects in this respect.

Mercurials are remedies of undoubted power in many cases of dysentery,
but we doubt whether they should ever be pushed to salivation. In cases un-
accompanied by intense irritability of the stomach and bowels, they excite a
flow of bile and open the other secretions, and thereby accelerate the cure; but
their use is generally far from being indispensable.

We have frequently administered quinine in cases where we supposed it to
be most admissible, but we confess we have never been pleased with its action.
While it has never with us arrested the disease in one individual case, unless
complicated with well-marked intermittent fever, it has often aggravated the
symptoms, and in our opinion protracted the cure. We regret that our expe-
rience in this particular does not correspond with that of others, whose testi-
mony is worthy of the highest respect. The practice of the one or the other
must be based upon erroneous pathological views, and are liable at least to
result in injurious consequences. A case illustrating the questionable influ-
ence of quinine in dysentery occurred not long since, in the person of an emi-
nent physician in a neighboring county, who during the prevalence o^this dis-
ease declared, should he be attacked by it, he would never die by debility or
for the want of an anti-periodic. Soon after he was attacked by dysentery,
and he plied thoroughly, as he intended, quinine, his sovereign remedy. His
disease proved intractable, and he died without the slightest alleviation of his
symptoms. On post mortem examination, his colon was found to be one mass
of ulceration.

We are inclined to believe that physicians, attacked by dysentery, are more
likely to die than others, probably from their aversion to the full effects of opium,
as well as all other active remedies, in their own persons.

During its prevalence in Columbus, the disease has proved fatal in but few
instances. We regret to say that our ranks have been broken again, and that
one of our esteemed and reputable professional brethren has been stricken
down within a few weeks. Dr. Samuel Z. Seltzer, aged about 50 years, was
unexpectedly taken from among us by dysentery, while in the enjoyment of a
large practice and the unqualified respect of all who knew him.

(Ohio Med. and Surg. Journal.)

370 The New-Orleans Medical and Surgical Journal.

XI. — Physiological " Researches of M. Bernard.

Paris, June 21, 1852.

According to M. Bernard's view of the action of the gastric fluid and the
changes which the food undergoes in the stomach, it will readily be understood
that the <; chyme" will vary considerably in composition with the nature of the
alimentary materials. It has been formerly supposed that the chyme was a
homogenous fluid, resulting from the indiscriminate solution of all the digest-
able substances which had been taken into the stomach. In reality it is not
so, since it is only the albuminoid matters which are digested in the stomach
and the remaining alimentary principles pass into the intestine in the same, or
nearly the same condition in which they were swallowed. The chyme, then,
is a mixture of digested albuminoid matters, and undigested, oily, starchy, and
saccharine substances. It remains to be seen what becomes of these last. Our
method of ascertaining where and by what agents these matters are digested
is, to follow them downward in the intestine and discover at what point of the
alimentary canal the oil, or the starch, loses its natural physical and chemical
properties and becomes absorbable. Oily matters, for example, enter the duo-
denum unchanged; but at a certain distance from the pylorus they suffer an
alteration, are digested, in fact, and are no longer to be recognized by their
ordinary characters. This change commences in many animals immediately
below the opening of the biliary and pancreatic ducts, and as the bile appeared
to be the most abundant and important intestinal fluid, the digestion of fatty
substances has been attributed by some experimenters to this secretion. In
some animals, however, the ducts are separated by a considerable distance ;
and in all these instances it is the biliary duct which comes first, the pancreatic
duct afterward. In the rabbit, for example, the biliary duct opens at the upper
part of the duodenum, while the pancreatic joins the intestine some eighteen
inches farther down. In all cases where the ducts are so separated, the fat
can still be recognized in the intestine after it has passed the opening of the
biliary duct, and disappears only when it has been subjected to the action of the
pancreatic fluid. The digestion of oily matters, in other words, always cor-
responds, in place, to the opening of the pancreatic duct. It occurs high up
in the intestine when the duct is situated high, and lower down, when the duct
opens lower down. There is, then, the most complete proof that can be drawn
from comparative anatomy, that it is the pancreatic fluid that accomplishes the
digestion of oily substances.

But a still more interesting proof is obtained by the method which M. Ber-
nard has already followed with the saliva and the gastric juice, viz., by obtain-
ing the fresh secretion from a living animal, and trying, by direct experiment,
its action on the alimentary principles. For this purpose he takes a dog, in
whom the processes of digestion are actively going on, makes a short incision
into the abdomen, a little to the right of the median line, finds the pancreatic
duct by feeling, introduces a slender silver canula, and allows the secretion to
drain away into a small India rubber reservoir, until enough has been accumu-
lated for experiment. This requires only a short time, if digestion is going
on when the operation is done. He then takes fresh bile, saliva (the different
varieties) and gastric fluid, obtained in the same manner. Olive oil shaken up
with these different fluids in test tubes, is only mechanically mixed with them;
but when it is poured into a test tube containing fresh pancreatic fluid, it is
immediately emulsionedin the most complete manner; and the fluid, which
was transparent and limpid like water, becomes at once white and opaque as
milk. If the emulsion be exposed for some time to the air, at a temperature
of 40 ° cent, it suffers a further change, and from alkaline becomes acid, in
consequence of the fat being decomposed into glycerine and a free fatty acid.

Excerpla.

371

This last change, however, is entirely artificial, and does not take place in na-
tural digestion. In the intestine the oil is simply emulsioned, and still retains
its peculiar chemical character. It is therefore absorbed as oil, but in a state
of minute subdivision.

When the fresh pancreatic secretion is'obtained from the living animal, in
the manner indicated above, it is a clear, watery fluid, with a distinct alkaline
reaction. It has the following composition :

Water, - 91.28

Organic Matter, - 0.44
Ashes, - 8.28

100.00

Free Soda,
Chloride of Sodium,

" Potassium,
Lactate of Lime,
Alkaline Carbonates,
Phosphate of Lime.

To which of these ingredients does the pancreatic fluid owe its peculiar pro-
perty of emulsioning fat ? It is not the free soda or the alkaline carbonates,
since the saliva and the bile are equally alkaline but have no similar effect on
oils. The contents of the intestines also are in many animals constantly acid,
and would therefore effectually prevent any action that depended on the alka-
line qualities of the secretion. The pancreatic fluid, like the gastric juice,
owes its digestive properties to the organic matter which it holds in solution.
This organic matter, like that of the gastric juice, is precipitable by alcohol ;
and the precipitate, drained, washed, and redissolved in water, retains all its
original properties. Its solution has the property of emulsioning oily substan-
ces in the same manner as the natural pancreatic fluid.

The active principle of the pancreatic fluid has some points of resemblance
with albumen, since it is precipitated both by heat and alcohol. It is not albu-
men, however, since neither the white of an egg, nor the albumen of the blood,
have any similar action on oils. It differs from albumen also, in some chemi-
cal characters ; as its alcoholic precipitate is easily soluble again in water,
while albumen, once precipitated, cannot be again dissolved. It resembles
casein also, in some respects. It is precipitated, for example, like casein, by
sulphate of magnesia in excess. As the casein in milk apparently seems to
hold its oily part in emulsion, so the pancreatic fluid in the intestines exerts a
similar action on the oleaginous ingredients of the food ; so that there is, in
reality, considerable resemblance in the physiological properties of the two
substances. They are not, however, identical, since the pancreatic fluid is
coagulated by heat, which has no effect, on a solution of casein. Bernard finds
that fresh pancreatic fluid constantly coagulates by heat. Other experimenters,
particularly in Germany, have stated the contrary, and maintained that the
secretion was unaffected by heat. This difference in the result of the experi-
ments Bernard explains by the fact, that the pancreatic secretion becomes
altered very soon after the operation of making an artificial fistula. Even in
dogs, who bear these operations on the abdomen with greater impunity than
most animals, the partial peritonitis, which is soon established about the wound,
vitiates the secretion of the pancreas to such a degree, that it will no longer
coagulate by heat, nor exert its proper action on oily substances. For purpo-
ses of experiment, it is always necessary to take the first fluid secreted after
the performance of the operation.

The active principle of the pancreatic fluid must, then, be considered as a

372

The New-Orleans Medical and Surgical Journal.

peculiar organic matter, which gives to the secretion the power of emulsioning
oily substances.

There is still another class of alimentary principles, namely, the amylaceous,
which acquire to be modified by the action of the intestinal fluids. Starch is
no more absorbable in its natural condition than fat, and to become absorbable,
it is transformed first into dextrine, and next into sugar ; and it is finally ab-
sorbed into the circulation under the form of sugar. There is one thing, how-
ever, remarkable about the digestion of starchy substances. While the diges-
tion of both the other orders of alimentary principles, albuminoid and oleagin-
ous, is strictly localized, so to speak, i. e., is performed in particular parts of
the alimentary canal, and by means of special secretions, the digestion of
starchy substances is not so, but takes place indiscriminately throughout the
whole length of the digestive tube, below the stomach. All the intestinal
fluids have, more or less, the property of converting starch into sugar. Sim-
ple contact with any part of the intestinal mucous membrane is alone sufficient
to effect the change.

There are, then, three different digestions, so to speak, carried on in the
alimentary canal ; a different process being required for each of the three prin-
cipal orders of alimentary substances, and at the same time there are three
different products resulting from their modification. First, the albuminoid mat-
ters are dissolved by the gastric fluid in the stomach and converted into " albu-
minose ;" a substance which is not coagulated by heat or the strong acids,
but only by some metallic salts, \lbumen, fibrin and casein, are all three
converted by stomach digestion into this secondary principle. Secondly,
fatty substances are converted into an oily emulsion by the pancreatic fluid in
the duodenum ; and thirdly, starch is transformed into sugar by the action of
the intestinal fluids generally.

It will be seen that no account has yet been given of the nature and action
of the bile ; a secretion which seems particularly difficult of study, notwith-
standing its great abundance and the ease with which it may be obtained for
purposes of experiment. M. Bernard's explanation of its physiological pro-
perties will not, probably, appear by any means so clear and satisfactory as
that which he gives of the other digestive fluids. One cannot help suspecting,
indeed, that he is not entirely satisfied with his own ideas on this point. Such
as they are, however, you shall have them, and form your own opinion as to
their merits.

It has already been said that the bile has the property of converting starch
into sugar. But this property is one which it possesses in common with all
the other intestinal fluids, and cannot be considered as at all characteristic.
The bile, in fact, has by itself no special action on any of the alimentary
principles. Neither oleaginous nor albuminoid matters, in their natural con-
dition, suffer any change by being placed in contact with it. But if albuminoid
matters, which have already passed through the stomach be mixed with bile,
an immediate action becomes evident. In all animals the opening of the biliary
duct is situated at a very short distance from the pylorus; so that the food, on
passing out of the stomach, comes immediately in contact with the biliary se-
cretion. The effect of this contact is to produce a copious yellowish precipi-
tate. Matters which were held in solutiou by the gastric fluid are thrown
down by the bile. In other words, the chemical actions which had been going
on in the stomach are arrested as soon as the food enters the duodenum. At
this part of the alimentary canal a new set of actions is about to commence ;
and in order that they may be properly accomplished, it is necessary that those
which have preceded them should be checked. For there is an essential dif-
ference, a kind of opposition, between the changes which the food undergoes
in the stomach, and those which are to take place in the intestine; The pro-
cesses of stomach digestion, are essentially antiseptic. They are analogous

Excerpta.

373

to those produced by the prolonged action of fire. Fibrin, for example, is
transformed into albuminose. Fat which is not chemically changed, is simply
melted. Starch in the stomach merely swells up and becomes "hydrated, ex-
actly as it does by boiling in water. On all the alimentary matters the effect
of stomach digestion is analogous to a kind of cooking, and is entirely anti-
putrefactive. The gastric fluid is itself anti-putrefactive, and very little liable
to change. It may be preserved for an indefinite length of time without losing
its digestive properties.

On the other hand, the pancreatic fluid is extremely liable to putrefaction
and changes very rapidly by exposure ; so that a very short time after it has
been secreted, it can no longer be used for purposes of experiment. Since
there is this opposition between the actions of the gastric and pancreatic
fluids, they would necessarily interfere with each other, were there not some
secretion intermediate between the two, which should neutralize the action of
the gastric juice before the contents of the stomach come to be mingled with
the pancreatic fluid. The bile is such a secretion. It immediately destroys
the gastric fluid and arrests its action; and in fact, it is found by direct experi-
ment, that if the bile be injected into the stomach of a living animal, it effectu-
ally stops, for a time, the digestive process.

Another effect of the presence of bile in the intestine seems to be, to regu-
late the chemical changes which go on there, in such away that the products
of these changes are not the same that they would be out of the body. The
decomposition of azotized organic matter, for example, out of the body, always
gives rise to ammoniacal products. On the other hand, the substances result-
ing from the decomposition of non-azotized matters are always acid. Starch
is transformed first into dextrine and sugar, and a continuation of the process
produces lactic acid. Fats are decomposed into glycerin and a free fatty acid.
In the intestine, however, exactly the contrary is the case. The internal sur-
face of the intestine of carnivorous animals has always an acid, that of herbi-
vorous animals an alkaline reaction. The azotized matters give rise to acid
products, and the non-azotized to alkaline. This modification of the chemical
changes, as they take place in the intestine, is referred to an influence exerted
by the presence of the bile.

Such is M. Bernard's account of the character and functions of the bile.
The secretion is so evidently one of a very complicated character, that perhaps
it is not surprising that we have not yet entirely mastered its physiological
history. Unlike other secretions, a large portion of it, after being once poured
out by the secretory duct is reabsorbed, during its passage down the intes-
tine. In the rabbit, for example, it is estimated that a quantity of bile is
secreted daily amounting to one eighth or one tenth the weight of the whole
body. But four fifths of this quantity are reabsorbed before it reaches the
end of the intestine, and it is only a small portion, consisting mainly of the
bitter principle and coloring matter, which is finally rejected with the re-
fuse parts of the food. The liver is not only a secretory and an excretory
organ, but is destined at the same time to accomplish certain other processes
in the preparation of the blood, which are still more obscure and complicated,
as will be seen from what follows on the absorption of the digested portions of
the food.

The three alimentary substances which have been subjected to different di-
gestive processes in the stomach and intestine, and which have respectively
been converted into albuminose, sugar and an oily emulsion, are afterwards
absorbed into the circulation. But they are not all absorbed by the same ves-
sels. There are two different routes which these substances follow in leaving
the cavity of the intestinal canals — 1st, the portal vein ; 2d, the lacteals. All
the albuminoid and amylaceous substances pass by the portal vein ; all the
fatty matters are taken up by the lacteals. The chyle, which was formerly
supposed to contain all the products of digestion, in reality only contains one

374

The New-Orleans Medical and Surgical Journal.

class of them, the oleaginous. The two other classes are absorbed by another
system of vessels. The anatomy of the portal vein on the one hand, and of
the lacteals on the other, make it evident that all the alimentary materials, after
absorption* and before entering the general circulation, are compelled to pass
through certain preparatory organs. The oleaginous matters, entering the
subclavian vein by the thoracic duct, are taken directly to the lungs. The
albuminoid and amylaceous substances, taken up by the portal system, must
pass through the liver before they are mingled with the rest of the blood in
circulation. In these organs, the substances which have been absorbed are
destined to undergo a further modification before they can be used for purposes
of assimilation. Even albumen is not assimilable until it has passed through
the hepatic circulation. If pure albumen be injected into the jugular vein of
an animal, it is not assimilated, but is excreted in the urine as albumen. But
if it be injected into the portal vein, it passes through the liver, becomes assim-
ilable, and no longer appears in the urine. Cane sugar, absorbed by the portal
system, is converted in the liver into grape sugar. Oleaginous matters suffer
some analogous change in the lungs, by which they are rendered fit to be used
in the processes of nutrition. For these reasons, it appears at least doubtful
whether it be possible to support life to any extent by means of " nutritive
baths," which have sometimes been used for the purpose. Nutritive enemata
are undoubtedly useful, since the albuminoid matters are taken up by the por-
tal system and carried to the liver. But when absorbed by the vessels of the
skin, they are not yet fit for assimilation, and must therefore be excreted in the
same manner as when injected into the jugular vein. The digestive processes,
therefore, or that by which the elements of the food are prepared for conver-
sion into blood, far from being a simple process, performed in the stomach alone
by the gastric juice, is not even completed in the interior of the alimentary
canal. But the nutritive matters, after being rendered absorbable, have still
other changes to undergo in the lungs and liver, by which they are made assi-
milable, and these must necessarily be considered as essential parts of the pro-
cess of digestion.

A few days ago I had the pleasure of seeing, in M. Bernard's laboratory,
two experiments which I had heard of before, but which it is difficult to believe
in thoroughly, without the evidence of one's own senses. The first was a de-
monstration of the manufacture of sugar in the liver ; the second, the produc-
tion of diabetes mellitus in a rabbit, by wounding the posterior part of the me-
dulla oblongata. Both experiments were completely successful.

M. Bernard maintains, that one of the constant and normal functions of the
liver is the production of sugar. In all animals, dead suddenly while in good
health, in the human subject under similar circumstances, in executed crimi-
nals, etc., the blood of the liver and of the hepatic vein, and the substance of
the liver itself, is found to contain a very appreciable quantity of sugar (glu-
cose); and this, when no sugar or starch has been taken for food, and when it
cannot be discovered in the contents of the intestines, nor in the blood of the
portal vein below the liver. Any serious indisposition checks this production
of sugar, in the same way as it checks the secretion of gastric juice, of cuta-
neous perspiration, etc. But in a state of health it is a constant phenomenon.
The sugar thus produced by the liver is destroyed in the lungs ; consequently
it is not found in the general circulation, nor in any other organ in the body
than the liver.

To prove this fact, M. Bernard took a young dog that had been fed all the
morning on animal food, and killed him instantaneously by destroying the me-
dulla oblongata by a kind of " garote." The abdomen was immediately opened,
and a ligature placed on the portal vein, just below the liver, another on the
hepatic vein, just above, and a quantity of blood taken from each of these two
situations to be tested. Each portion was subjected to the same process of

Excerpta.

375

coagulation, decolorizing, etc., and afterwards tried by the same reagents — tar-
trate of potass and copper, with heat. The blood from the portal vein, which
had not yet passed through the liver, showed no alteration whatever; in the
other specimen a copious precipitate of the suboxide of copper took place, as
abundant as is often seen in cases of diabetes mellitus. The substance of the
liver, brayed in a mortar and extracted with water, showed the same reaction,
while the substance of the lungs, treated in a similar manner, showing nothing
of the kind. The fermentation test was also applied, but was altogether su-
perfluous, as the results of the first were completely satisfactory.

The second experiment is as follows :

A rabbit is taken, and the bladder emptied by compressing the hypogastrium.
The urine is tested for sugar, and as might be expected, shows no trace of it.
A small steel instrument is then passed through the posterior part of the skull,
into the substance of the medulla oblongata, and is immediately withdrawn.
The instrument has a transverse cutting edge, like a chisel, a little over one
line in length. From the middle of this edge a fine steel point runs out in
the axis of the shaft for about two lines. This point is to prevent the cutting
edge from passing through the medulla, and wounding its anterior fibres, which
would destroy the animal. It is the posterior portion of the medulla alone that
is to be wounded by the cutting edge. The instrument is then passed forward
in the median line until the steel point rests upon the basilar process of the oc-
cipital bone, when it is immediately withdrawn. If the puncture has been
made accurately in the median line, the animal makes no struggle during the
operation, and appears simply feeble and exhausted afterwards. He soon at-
tempts, indeed, to use his limbs, and in a few days is generally quite recovered.
If the instrument has divided considerably to either side, the animal presents
the singular phenomenon of constantly turning towards the wounded side
whenever he attempts to move.

In the course of two hours after the operation, the urine tested by the tartrate
of potass and copper, shows an abundance of grape sugar in solution ; and
the blood taken from the jugular vein also contains a considerable quantity.
This state of artificial diabetes continues, in the rabbit, from thirty-six to
forty-eight hours. At the end of that time the sugar disappears from the blood
and secretions, and the animal returns to its natural condition, after which the
state of diabetes may be again made by a fresh puncture. Indeed the experi-
ment, if carefully performed, may be repeated several times upon the same
animal.

The explanation of this singular phenomenon is not altogether easy. It is
considered by M. Bernard as illustrating the connection between the cerebro-
spinal and sympathetic nervous systems. But however it may be interpreted,
the fact itself is incontestible.

Yours, truly,

JOHN C. DALTON, Jr.

(Buffalo Med. Jour.)

XII. — Gun-Shot Wound of the Neck — Ligature of the Vertebral Artery.

In the number for April, 1852, of the Jour, des Connaiss. Med. Chirurg., we
find the particulars of the following unique and very interesting case detailed,
the material facts of which we shall translate for our readers.

376 The New-Orleans Medical and Surgical Journal.

About the 11th of February, 1852, Madame X was wounded by a pistol

ball in the anterior region of the neck. On examination of the patient soon
after the accident, Messrs. Maisonneuve and Favot found, in a line with the
left lateral half of the cricoid cartilage, a circular wound of small size, which,
at first glance, did not seem to penetrate to any great depth ; but on ascertaining
the circumstances attending the accident, they learned that the hemorrhage was
alarming. From this fact the physicians concluded that the ball had penetrated
a considerable depth; which surmise was confirmed on further examination.
At this time there was some swelling on the left side of the neck, accompanied
with great pain, which extended and diffused itself through the upper extremi-
ties, especially to the left arm, which was also swollen and tender.

Both the respiration and voice were natural; deglutition was easy, and indeed
all the other functions were normal. By the introduction of a stylet, it was
ascertained that the cricoid cartilage on the left side was exposed, — that the
ball having struck this body, glided afterwards from above downwards, along
the side of the trachea and the oesophagus, on the inner side of the carotid ar-
tery, the internal jugular vein and the pneumo-gastric nerves — then penetrated
as deep as the spine, where it was buried in the sixth cervical vertebra. In its
bed, the ball was distinctly felt by the physicians, who made some fruitless ef-
forts to extract it ; but as often as they seized it and began to use traction, the
pains became atrocious and intolerable, and the patient was threatened with
syncope. This caused them to abandon any further trials to remove the lead,
as they feared a fatal result, should they succeed. The patient was then put
upon the antiphlogistic plan of treatment, — was bled five or six times during
the four first days, — took anodynes, and was kept perfectly at rest. Under
this treatment the condition of the patient became greatly ameliorated. With
an abatement of the general symptoms, the swelling about the neck also sub-
sided, and hopes were now entertained that Madame X might re-
cover.

But on the 19th of February, the eighth day after the accident, a profuse
hemorrhage took place from the wound, which ceased spontaneously. On the
morning of the 20th the hemorrhage was again renewed, but again ceased;
finally, on the evening of the. same day the blood again began to start from
the wound with increased violence. It was now deemed absolutely necessary
to act promptly to save the patient ; and at this time a third physician, Doctor
Tardieu, was called in consultation. He failing to reach the patient in due
time, and the case being pressing, Doctors Maisonneuve and Favot proceeded
to cast a ligature about the vertebral artery — the first operation of the kind, we
believe, in the annals of surgery.

The Operation. — An incision, about 15 centimetres long, was made along the
anterior border of the sterno-mastoid muscle, a little exterior to the place where
the ball entered. Then the carotid artery and internal jugular vein were ex-
posed.— both of which were untouched — the ball having passed on the outside
and slightly denuded, but did not wound them. Through the large wound
thus made, Messrs. M. and F. readily discovered the cricoid cartilage, the left

Excerpta.

377

lateral part of which had been grazed; the first rings of the trachea and the
oesophagus, which the ball had laid bare, without doing much damage ; then
on looking deeper into the wound, to discover the bleeding vessel, they found
the ball buried in the sixth cervical vertebra ; this they immediately extracted,
when a terrific hemorrhage took place. By the introduction of the finger into
the wound made by the lead in the vertebra, the bleeding was arrested ; but it
was speedily renewed when the finger was withdrawn. This experiment was
repeated several times. Now it was thought that the blood escaped from the
vertebral artery, which had been wounded in the canal of the transverse apo-
physis of the vertebra. In this state of uncertainty, and having no precedent
to guide them, they nevertheless found it necessary to act, to save the patient.
With one finger upon the mouth of the bleeding vessel, they carefully carried
on the dissection, and finally reached the vertebral artery which poured out
the blood. The vessel was then seized with pince a coulant, which was then
closed to arrest the hemorrhage. The facility, say MM. Maisonneuve and Fa-
vot, with which this was done, led us to believe that at first we had been de-
ceived, and that instead of the vertebral, we had only seized the inferier thyroi-
deal artery. We shall not stop, continue these bold surgeons, to show how the
vertebral artery, which was found concealed at this point in the bony canal,
could be made directly accessible at this point to our instruments. We shall
explain this fact hereafter. After having thus seized the vessel, we passed
Cooper's curved needle beneath it, which had been previously armed with a
double ligature ; with one of these the vessel was tied below, and with the
other above the forceps.

This feat in surgery gave infinite satisfaction to those gentlemen, who saw
that the vessel had been effectually ligated, and the hemorrhage arrested.
Another superficial artery, which was ascertained to be the inferior thyroideal,
was then tied, without difficulty.

During this long operation the patient was under the influence of chloro-
form. The operation finished, the wound was united half its length by ad-
hesive plasters, aided by a few stitches. No untoward accident checked the
progress of the case ; and on the 29th of February the ligature was removed
without difficulty. From this dats the patient continued to improve up to the
5th of March. At this^time febrile symptoms, without previous signs, mani-
fested themselves, after violent mental emotion, and contiuued without inter-
ruption up to two o'clock on the 9th of March, when suddenly, during the
toilette of the patient, she was seized with violent pain in the region of the
neck — suddenly cried out, and fell into profound coma. At 9 o'clock in the
evening the patient succumbed, in spite of the most energetic treatment.

Autopsy 36 liours after death, — The post-mortem revealed the following facts:
The wound in the neck, cicatrized now only along its superior half, extended
by an oblique trajet as far as the body of the sixth cervical vertebra, on the
inner edge of which lay the trachea and the oesophagus ; and on the outer
border, the carotid artery, the internal jugular vein, and pneumo-gastric nerve..
The inferior thyroideal artery, which had been divided during the operation,

378 The New-Orleans Medical and Surgical Journal.

contained a solid clot, about two centimetres in length ; the transverse apophy-
sis of the sixth cervical vertebra was broken, and thus exposed the vertebral ar-
tery divided, — the upper and lower extremities of which were filled with a solid
clot, about three centimetres. Behind the vertebral artery, the 5th pair of
cervical nerves were discovered ; in front of these parts the body of the verte-
bra was traversed (creuse) by a deep canal, the extremity of which communi-
cated with the spinal canal by a small opening — evidently produced in the lat-
ter days of the patient, and caused by necrosis of the osseous lamella,^ which
formed the deep seated limits to the wound. The spongy tissue of the bone
was infiltrated with pus ; a sero-purulent exudation was found in the spinal
canal, both in the external cellular tissue and in the subserous envelops of the
medulla spinalis. No other important lesion was found in any part of the
body.

Remarks. — We have endeavored to describe one of the most remarkable, and
we believe unique operations which have yet appeared on the records of sur-
gery ; and but for the high standing and great reputation of the surgeons who
assisted at the operation, some doubts might arise in the mind of the reader as
to the practicability of performing it. That the vertebral artery may be wound-
ed, without other serious injury to vital parts, is well known to every anatom-
ist; and we have reported in Vol. VI. for 1849 — 50 of the Journal, a case of
traumatic aneurism, caused by a wound of this artery. The patient was a slave
man, who was wounded in a fracas in the neck, with some pointed instrument;
the hemorrhage was profuse at the time, but was arrested. The wound healed,
and a tumor made its appearance in the place of the wound ; both the carotid
artery and internal jugular vein escaped uninjured. Dr. Stone of this city, who
treated and reported the case, thought one of the vertebral arteries had been
wounded. In the meantime the tumor increased, and was on the point of
bursting, when he determined to open it, let out its contents, and secure any
vessel that might be wounded- This was done, when after the evacuation of a
small portion of coagulum, a sudden gush of arterial blood took place. Doctor
Stone placed his thumb upon the carotid artery, but this did not check the
bleeding ; the wound was then enlarged, the entire coagulum turned out, and
then it was ascertained that the vertebral artery of the left side had been
wounded. The hemorrhage was now controlled by thrusting the finger over
the artery whence it coursed, between the transverse processes of the verte-
bra; the wound was carefully plugged up with lint — when the hemorrhage
ceased definitively. The wound soon granulated, filled up, and in a short time
the boy entirely recovered. What a misfortune our Gallic friends did not fcl.
low the treatment of Dr. Stone in that case. Perhaps it was too simple, and
an opportunity for performing a new surgical operation would not be permitted
to escape them. Let those who desire to save their patients in similar dan-
gers, adopt the method of the American surgeon.

(Ed. N. O. Med. Jour.)

Excerpta. 379

XJIT — Neuralgic Amaurosis.

In a work recently written by M. Tavignot on neuralgic amaurosis, and
presented to the Academy of Medicine of Paris, we find the following conclu-
ding observations on this subject. I give, says M. Tavignot, the name neural-
gic amaurosis to paralysis, either complete or incomplete, partial or general,
of the retina, supervening under the influence of neuralgia of the 5th pair of
nerves. The action exerted upon the eye by the 5th pair, when affected with
neuralgia, is regulated by certain laws which may be formulated. M. Tavig-
not admits two species of neuralgic amaurosis, which are very distinct in
their characters. The cause of one is a neuralgic state of the extra-orbital
branches of the trigeminus ; this he calls extra-orbilal neuralgic amaurosis ;
the other is produced by a neuralgic state of the ciliary nerves of the 5th pair;
this he denominates intra-orbilal neuralgic amaurosis.

First — Of extra-orbital neuralgic amaurosis. — Extra orbital neuralgia of the
5th pair acts upon the retina, M. T. thinks, and induces paralysis of this mem-
brane. This paralysis results from a want of equilibrium in the distribution of
the nervous influx, as if the exaggerated loss of this fluid by the extra- orbital
branches had taken place at the expense of the ciliary nerves. The march of
extra-orbital neuralgic amaurosis is governed by the intensity of the neuralgic
paroxysm — their duration and their frequency. It depends, moreover, upon
the greater or less persistence, in the interval of the paroxysm, of the painful
points existing on a level with a terminal division of the nerves — especially
towards the summit of the head — upon the lateral parts of the nose — the upper
lids, etc.

Second — Of intra-orbilal neuralgic amaurosis. — When neuralgia is located
in the ciliary nerves — although this neuralgia may be simple or associated
with neuralgia of the extra-orbital branches, still there supervenes a functional
perturbation of the retina ; not the greater for the absence, but rather on ac-
count of the excess of nervous influx. Both forms of neuralgic amaurosis ap-
pear to have an analogous origin, although they differ completely in their
symptoms.

The starting point of neuralgic amaurosis, regarded in a general manner,
appears to consist in an anormal state of the blood, resulting from irregular
assimilation, or from desasimilation. General treatment can alone be depended
on in these cases. ( Journal Frangais.)

Part ® l)iri>.

REVIEWS AND NOTICES OF NEW WORKS.

I.— Clinical Reports on Continued Fever, based on Analysis of 164
Cases ; with remarks on the Management of Continued Fever ; the
Identity of Typhus and Typhoid Fever ; Relapsing Fever ; Diagno-
sis, etc,, etc. By Austin Flint, M. D., Professor of the Principles
and Practice of Medicine in the University of Buffalo, and Editor of
the Buffalo Medical Journal. Buffalo, N. Y., 1852. pp. 390.

As continued fevers, {Typhoid and Typhus,) have, of late years,
become so much more common than formerly throughout the Southern
and Western States — since, in fact, they seem to be supplanting, as it
were, the more ordinary types of Endemic Fever, it is certainly desir
able that the Profession in these parts should be put in possession of
all the established facts and the most plausible theories that have been
published respecting the causes, nature and management of these dis-
eases. The work before us will go far toward supplying this desidera-
tum, and we earnestly commend it to the attention of those who are
disposed, as they should be, to investigate the subject. It consists of a
series of minute and careful observations made at the bedside of a large
number of cases, and embracing nearly every point concerning which
information may be desired. In our whole reading we have rarely met
with any thing superior to its graphic and minute symptomatology, its
carefully drawn diagnosis and its excellent description of post mortem
appearances. The author seems to have taken the celebrated work of
Louis on Fever as his model ; and in respect to minute and faithful ob-
servation and philosophical induction, may set up no mean pretension
to rivalry with that distinguished pathologist.

As we are not allowed either time or space for a lengthy review of
Dr. Flint's work, we shall only touch upon some of the most interesting

Reviews — Dr. Flint on Continued Fever.

381

topics, and beg leave to assure the reader that he will find in it a large
amount of valuable information. But few men possess sufficient indus-
try to record so extensive and varied an amount of noted facts as is
presented in this book, and but few have the talent to show, as Dr. F.
does, the rational inferences which they authorize.

When it is recollected that this work is composed of actual bed-side
observations in one hundred and sixty-four cases of Continued Fever,
we know of no better way of giving our readers a correct idea of its va-
lue than by briefly running over its contents. It is divided into 14 Sec-
tions and a Supplement. The topics are as follows :

Section 1st. — Age. Occupation. Civil Condition. Nativity. Ha-
bits. Season. Constitution and previous health of the patient. Period
of residence. Duration of the disease before coming under observa-
tion.

Section 2d, — The access. Its duration and symptoms. Circumstan-
ces supposed to have been instrumental in the production of the dis-
ease.

Section 3d. — Symptoms referable to the general aspect. Expression
of countenance. Decubitus.

Section 4th. — Symptoms referable to the nervous system. Mind.
Sleep. Coma. Senses and sensibility. Muscular contractions, etc.

Section 5th. — Symptoms referable to the digestive system. Appetite.
Thirst. Tongue. Parotitis. Nausea and Vomiting. Alvine dejec-
tions. Tympanitis. Tenderness of abdomen. Gurgling.

Section 6th.-— Cutaneous Eruptions.

Section 7th. — Symptoms referable to the respiratory apparatus. Cough,
Expectoration. Pains in the chest. Pneumonitis. Epistaxis. Sin-
gultus.

Section 8th. — Symptoms referable to the circulation. Pulse. Capil-
lary Congestion.

Section 9th. — Symptoms (exclusive of eruptions) referable to the
skin.

Seetion 10th. — Symptoms referable to the genito-urinary system.
Section 11th. — Duration of the disease. Circumstances attending
convalescence. Sequelae. Mode of dying. Fatality.
Section 12th. — Examinations after death.
Section 13th. — Treatment.
Section 14th. — Cases of doubtful typp.

882 The New-Orleans Medical and Surgical Journal.

The supplementary articles relate to the symptoms distinctive of Ty-
phoid and Typhus Fever — the question of their identity — the differential
diagnosis— discrimination of Continued Fever from other affections —
characters distinguishing Remittent from Typhoid Fever — management
of Continued Fever — remarks on Relapsing Fever — Contagion, etc.,
etc.

The reader cannot fail to be pleased with this bill of fare, and must
surely feel a desire to discuss it. In the first of the Reports, Dr. Flint
displays much skepticism in regard to what has been claimed by the
French and some American Pathologists to be the distinctive characters
of Typhoid Fever, (ulceration of Payer's glands and the rose-colored
eruption,) making it a disease sui generis ; but in the end, he declares
his conviction of the truth of this position.

Now, with due deference to this respected author, we must contend
that this is a matter of no importance whatever. What do we care for
the characteristic anatomical lesion of Typhoid, Fever or any other dis-
ease, if a knowledge of it suggests nothing beneficial either in its pre-
vention or cure? These are the great objects of medical inquiry; and
if our researches do nothing more than enable us to say over the bodies
of the dead — this one died of Typhoid Fever, and this of Typhus, this
one of Yellow Fever, this of Bilious Remittent, etc., etc., our labor
and time will have been spent in vain. Our business is to cure dis-
eases, and in so far as an exact knowledge of their causes will suggest
appropriate remedies, it is well to have it ; but, without this exact know-
ledge of remote causes, we have still learned, by patient and careful
observation, so much of their effects upon the human system as enables
us both to prevent and cure many fatal diseases. We cannot but think
that the ulceration of Peyer's glands, so often met with in Typhoid Fe-
ver, is one of the effects of general morbid action which has been going
on in the system for a considerable time, and that this lesion does not
of itself alone constitute the disease. Nor can it be relied on as a
diagnostic sign, because we cannot be positively sure of its existence
until it is demonstrated by examination after death. The best Patholo-
gists differ as to the importance that should be attached to it ; and we
believe all agree that its extent bears no uniform relation to the sever-
ity of the symptoms during life. These glands have been found exten-
sively disorganized in cases that presented very mild symptoms; and on
the contrary were very slightly affected in cases that had presented the
most violent and distressing symptoms. Typhoid Fever is not the only
disease in which morbid development of Peyer's glands is found. We
know, from actual observation, that it is exceedingly common in Yel-

Reviews, — Dr. Flint on Continued Fever.

383

low Fever. But, admitting that this lesion and the rose-colored spots
invariably attend Typhoid Fever and enable us to distinguish it from
Typhus, of what use or benefit to us are these facts ? Do they lead to
any difference or improvement of treatment ? We believe not. Most
writers recommend the same general plan of treatment, even the same
remedies for both types. We therefore think that much useless labor
is expended upon these nice but insignificant points. Dr. Watson says,
" there is but one species, although there are many varieties of Con-
tinued Fever" — and lays down pretty much the same precepts for the
management ofthe whole. Dr. Flint says, " The general principles of
management are applicable alike to Typhus and Typhoid forms of Con.
tinued Fever."

We have been taken to task for venturing to express the opinion that
Typhoid Fever is not a distinct disease, sui generis, but only one of the
Protean forms or types of endemic malarious fever. So far are we
from being convinced of our error by the remarks of our critics, that
we are now strongly inclined to go still further, and with John Arm-
strong, include Typhus in the same category. After writing his cele-
brated work on Typhus, Dr. Armstrong added an Appendix in which
he declared that his views respecting the origin of this type of fever
had undergone a complete revolution. He saw fever cases that com-
menced as distinct intermittents go on to the remittent type, and from
that into as well marked Typhus as he ever witnessed. He also saw
Typhus taper offj as it were, into remittent, and from that into the inter-
mittent type. We beg the reader to refer to his works for the facts.
On this point, however, we invite special attention to the 2d Section of
Dr. Flint's work, which treats of the "circumstances supposed to have
been concerned in the production of the disease." Here will be found
some interesting facts going to support the views we entertain.

Dr. Flint's chapter " on the management of Continued Fever1' is very
interesting. After alluding to the various difficulties that lie in the way
of a scientific investigation of this important subject, he approaches it
by saying, " The management of Continued Fever may be considered
to embrace, first, abortive methods, or measures designed to arrest the
progress of the disease, or abridge its duration ; second, the treatment
of the disease irrespective of abortive measures, and without reference
to co-existing or secondary affections ; third, the remedies required by
its complications. He then proceeds to give an exceedingly imperfect
account of the first of these methods, (the abortive,) sl much better and
fuller account of the second, and some excellent advice respecting the

384 The New-Orleans Medical and Surgical Journal.

management of the complications, such as pneumonitis, peritonitis, pa-
ratiditis and apoplectic coma. We have already indicated our decided
predilection for the abortive method, and as we have not been able to
find any fair trial of it on record, we shall endeavor to supply this de-
sideratum at our earliest convenience.

Dr. Flint gives a short chapter on what is termed " Relapsing Fe-
ver" but we confess that we have so much dislike to this refinement of
useless diagnosis, we must beg the reader to examine it himself.

The work concludes with a valuable article on " the Transportation
and Diffusion by Contagion of Typhoid Fever" in which the author
republishes a paper of his in the American Journal of the Medical Sci-
ences, published in July, 1845, giving an account of the Typhoid Fever
that prevailed in 1843 in a village near Buffalo, called North Boston.
The facts here presented go to show that the disease, under certain cir-
cumstances, is contagious.

We must here conclude our imperfect notice of this work by again
commending it to the special attention of Southern and Western Physi-
cians. Dr. Flint is one of the very best writers belonging to the Pro-
fession in this country, and we heartily congratulate the University of
Louisville on obtaining so valuable an acquisition to its Medical Faculty.
We learn that he has been elected to the chair lately filled by the illus-
trious Drake, and we cannot doubt that he will do so with credit to
himself and with satisfaction to all concerned.

E. D. F.

II. — Lectures on the Principles and Practice of Surgery. By Bransby
B. Cooper, F. R. S., Senior Surgeon to Guy's Hospital, etc. Phila-
delphia, Blanchard and Lea. 1852.

For more than twenty-five years, Mr. Cooper has been connected,
as Surgeon to Guy's Hospital, and during this long service in one of
the most famous Hospitals in Great Britain, gathered the facts and
thus laid the foundation for the work before us. It does not claim to
be a systematic work on the principles of Surgery ; for this would be
to depart from the lecture-system — a mode of imparting instruction now
fully appreciated.

The first lecture is devoted to the consideration of the blood and its
component parts ; the second to that of the blood-vessels, absorbent^

Reviews — Cooper on the Principles and Practice of Surgery. 385

etc.; whilst the third, by a natural and easy gradation, leads the author
to the subject of inflammation — that monstrum horrendum to the student
and young practitioner, which looms up before the vision of the former
in the lecture room, besprinkled with the blood of its victims, and ever
feasting but never sated with the work of death and destruction. But
all figure aside — we know of no single word in the vocabulary of Pa-
thology which has led to more serious mistakes, and inflicted more dis-
grace upon the practice of medicine, than the term " inflammation."
Book after book has been written — lecture upon lecture been delivered,
to exaggerate and to explain the meaning and define the exact defini-
tion of the term ; yet how few of us entertain accurate notions of this
complex phenomenon ! We admit, of course, the existence of inflam-
mation ; but we contend that the subject as held up to the student dur-
ing his curriculum, is calculated to give him exaggerated thoughts on
this subject, and, in some manner, to inspire him with terrible forebod-
ings of its effects upon the human system. To be convinced on this
subject, read the following remarks of Mr. Cooper at page 40. He
says :

" So universal is inflammation, that every disease, it may be said, either begins,
ends, or in some period of its progress is accompanied by it."

We italicise the foregoing, that the attention of the reader may be
made to dwell upon the dangerous tendency of such sweeping declara-
tions. Can more error be compressed into fewer words 1 Are such
doctrines creditable to a great teacher of Surgery ? Every neophyte
in practice must know by experience that such doctrines are untenable,
and if permitted to influence us at the bed-side, will frequently end in
disaster for the patient and mortification to the physician. Let us recal
to mind the hundred and one different forms of nervous diseases — not
more than half of which either " begins, ends, or is accompanied"
with inflammation in any stage of their progress. In consequence of
a better understanding of this subject, physicians of the South have, in
a great measure, thrown aside the lancet, and other anti-inflammalory
means.

Having thus repudiated the doctrine of blood-letting proclaimed by
Mr. Cooper, — and the result has been a greatly diminished mortality, —
a more speedy convalescence, and a material falling off in the fees of
the faculty. Thus it must ever follow, that as our views of Pathology
become more accurate and better defined, our Therapeutics must acquire
greater scope and assume more definiteness in their application. The
lancet and cups have given way to quinine and opium, in a number of

386

The New-Orleans Medical and Surgical Journal.

cases ; and febrile exacerbations are no longer recognized as necessa-
rily associated with gastritis, pleuritis, hepatitis, etc. The era for
" phlegmasias" is decidedly on the wane, and we are inclined to believe
that in less than half a century blood-letting, except in rare instances,
will be put down by the almost universal consent of the profession.
Other sedatives, besides digitalis, emetic tartar, veratrum viride, qui-
nine, etc, will be wrought out of the laboratory of the chemist, which
will meet all the indications in nearly every stage of inflammation.

Mr. Cooper's Lectures contain a large amount of useful information,
and may be had at Steel's, 60 Camp street.

III. — God in Disease, or the Manifestations of Design in Morbid Phe-
nomena. By James F. Duncan, M. D., Physician to Sir P. Dun's
Hospital, Dublin.

Transactions of the Twenty-ninth Annual Meeting of the Medical
Society of Virginia, together with the President's Annual Address
and the Constitution of the Society.

Transactions of the Medical Association of the State of Missouri, at
its Second Annual Meeting in April, 1852.

Hints to the People upon the Profession of Medicine. By W. Max-
well Wood, M. D., Surgeon U. S. N.

An Address delivered before the Medical Society of the State of Geor-
gia, at their Third Annual Meeting, held at Augusta, April, 1852.

God in Disease.

Many of the views presented to the reader in this volume have, as
the author claims for them, originality ; but guided as he has been by
an enlightened judgment and high moral and religious sentiment, much
will be found to interest the general as well as the medical reader.

Having stated the opinions that are entertained relative to the ex-
istence of disease in the world, and discarding a common one, " that i^
is a necessary condition of our present state of being," as not standing
the test of examination, any more than does the second opinion which
refers all visitations of sickness to the direct agency of the Evil Spirit.
It appears clear to the mind of the author, that since certain phenomena,
which in former ages were in operation, have ceased, there has been a
change in the government of the world, and that the power of wicked-

Reviews. — Addresses, Reports, etc.

387

ness has been controlled to a greater extent than formerly; this Satanic
influence in modern times is not supposed to have any immediate agen-
cy in the affairs of men, direct revelations from heaven have ceased,
miracles are not performed to dissuade men from vice, or to allure
them to virtue, and demoniacal possessions, though men do sometimes
" play such fantastic tricks before high heaven as make the angel8
weep," have no firm abiding place in our mortal coil.

The third opinion entertained upon this subject is, " that disease is
really the result of the divine appointment in every instance where it
occurs."

To those who deny the truth of Revelation this opinion can have no
weight ; if certain circumstances were purely fortuitous in their charac-
ter, then were it needless to refer to an intelligent First Cause ; the
argument, therefore, in support of this last opinion will address itself
especially to those who embrace the truth of Revelation.

"If," observes the author," "disease be the result of pure accident,
it will be characterized by the total absence of all method, contrivance
and design ; for it is irrational to believe that any thing can follow from
the blind operation of chance but irregularity and confusion. If, on
the contrary, it be the work of an intelligent agent, it will exhibit those
qualities in a high degree of perfection proportioned to the intelligence
possessed by him who is the author of it."

It is not claimed that the argument to establish the existence of an
Intelligent Author, as exhibited in the contrivance and execution of his
works, is a portion of the originality of the volume ; on the contrary,
its similarity to the writings of Paley in his Moral Philosophy and Na-
tural Theology, can readily be traced ; the dissimilarity consists in the
sources from which the argument is drawn — disease, the body racked
with pain, the existence of some fatal malady, or reason forsaking her
empire, and leaving but the fatuous maniac, are the sources from which
the author makes manifest " God in disease," and asserts his goodness,
wisdom and power in the governance of his creatures.

" The proper end of human government," remarks Paley, " is not so
much the satisfaction of justice, as the prevention of crime." The
punishment of an offender is intended to benefit society, by preventing
others from violating the supremacy of the laws ; and by analogy, the
Deity tempers the chastisement of disease with the rod of correction ;
viewing disease in this light, and not as a punishment, the writer next
brings forward the fact, " that disease did not occur in the world until

388

The New-Orleans Medical and Surgical Journal.

after the fall of Adam." In Paradise there was no sin before the fall,
neither was there disease.

At first sight this argument would favor the opinion that disease was
fastened upon the Adamic race as a punishment for transgression ; nor
do we find in the Second Chapter, in which the question is fully
discussed, an entire refutation of the opinion. After directing the reader
to the sickness of Lazarus, to Abijah the son of Jeroboam, and to the
whole history of Job, we find the following passage : 44 These instan-
ces are most important and instructive. They teach us that, in the
case of the Lord's children, sickness is often sent under circumstances
which do not warrant the idea, that the dispensation partakes even of
the nature of chastisement, much less of punishment It is en-
tirely the result of God's gracious purposes towards them." The Bible
represents God as being "angry with the wicked every day," and yet
they may not be visited with sickness and affliction, but on the contrary,
health and prosperity may smile around them ; the correction of sick-
ness is here withheld ; " the punishment of the sinner is reserved for a
future state."

The 3d, 4th, 5th, 6th and 7th Chapters treat of the evidence of the
design that is afforded by the existence of disease. Writers on natural
theology agree that one of the strongest arguments in support of their
views, consists in the beautiful adaptation of one part of creation to ano-
ther. Thus, for example, a large portion of the earth's garniture is
green, this color being best adapted to the eye ; and the moral as well
as the physical nature of man tending to harmonise with surrounding
circumstances, are evidences of design, skill and contrivance. As un-
interrupted prosperity and continued health and enjoyment might lead
men to forget the great end and aim of human existence, without the
intervention of some powerful stimulus, we have, in the opinion of the
author, disease, admirably adapted to meet that necessity. " How few,"
it is observed, " as we look around upon the world, appear to be in the
slightest degree impressed with their frail and perishing condition."
Sickness is calculated to awaken serious thoughts and to abstract the
mind from over-much care about the things of time, speaking in im-
pressive yet truthful tones, of the shortness and uncertainty of life, its
admonitions are truly salutary. " When sickness appears in circum-
stances favorable to the full development of the finer feelings of our
nature, how beautifully are they exhibited. The skill of the physician,
the sympathy of friends, the anxiety of immediate relatives, the tender-
ness of the mother, the devotedness of the wife — are all exerted to the
utmost."

Reviews. — Addresses, Reports, etc.

389

But it is not only in those diseases which are commonly fatal in their
character that design is exhibited ; it is not necessary that the words
of the Prophet, " thou art the man," should be directly applied, in order
to give efficacy to the text ; slighter attacks and milder diseases may
arrest the attention, and impress upon the mind of man, that " 'Tis the
Divinity that stirs within him."

The frequent accompaniment of sickness — -pain — is also significant
of design ; by it we are speedily admonished of departure from health
in some organ of the body ; and the insidious nature of some diseases
may, perhaps, be early arrested by the attention of the physician being
directed to its seat ; thus pain performs no unimportant part in forming
correct diagnosis whilst the absence of it in some cases may lead to
self-deception and the fostering of a too eager credulity. The effects
of pain is well described in softening the asperity of our nature, in the
following language : " Its tendency is to develop kind feelings between
man and man ; to excite a friendly sympathy on the part of others tow-
ards the person immediately afflicted. No sooner is an individual at-
tacked with illness, than a corresponding degree of interest is excited
on his behalf."

It having been asserted in the early part of this volume, as the sound-
est opinion which can be entertained on the subject, that God is the au-
thor of disease, or that it "is really the result of the Divine appoint-
ment in every instance where it occurs ;" and also that the existence
of disease, with pain, as its general attendant, affords abundant evidence
of design, wisdom and power ; the remaining chapters are principally
devoted to the processes of reparation, which occur in disease, to the
influence of which the recovery of very many patients may mainly be
attributed, whilst without this " vis medicatrix naturae," under the most
favorable circumstances, the physician often fails to attain a successful
issue. In illustration of this, the author first selects from the class of
fevers, which he divides into three distinct kinds — the periodic, the spe-
cific and the continued.

The next illustration is taken from the process of cicatrization ; and
the last from the power of selection that the absorbents appear to pos-
sess in the performance of their office. We deem it unnecessary to
pursue the author in these various illustrations ; in every point which
he aims to establish, perspicuity of style is added to familiar illus-
tration.

Upon the medical views which are found scattered through the pages

390 The New -Orleans Medical and Surgical Journal.

of the volume before us, it is also needless to offer special comment.
The book of Dr. Duncan may be read with interest and pleasure.

The " Old Dominion," in the Transactions of its Medical Society,
* has presented us with a pamphlet containing sixty-two pages, upon the
principle, we presume, that in any good work she " never tires." In
this pamphlet are recorded the proceedings of the last meeting of the
Society, together with the address of the President, Beverly R. Well-
ford, M. D.

The estimation in which Dr. Wellford's address was held by the
members of the Medical Society of Virginia, was evidenced by a reso-
lution requesting its re-delivery before the Legislature and citizens of
that State — a compliment which the merit of the production well de-
served.

The occasional vein of satire which steals into its pages, applying
its potential cautery, where cautery were most needed, and leaving the
healthy blush to bespeak the skill of the operator, however distasteful
to those who need

" Some sweet oblivious antidote"

to cleanse the inward part, may not be the least profitable part of the
address. There is much in it which forcibly reminds us of the address
of the late Dr. W. P. Hort on Medical Education, delivered before the
Louisiana State Medical Society, at its Second Annual Session. In
each paper the necessity for reform is ably advocated, and the princi-
ples upon which it is to be accomplished have in each writer an unity
of sentiment.

Dr. Wellford urges upon Medical Colleges and Universities the con-
sideration of the resolutions and suggestions of the National Medical
Association, which are to be found in the published proceedings of that
body.

Without wishing to undervalue the importance of properly regulated
medical schools, and the benefit to be derived from their able teachers,
Dr. Wellford argues that there should be no " inherent property of the
diploma" by which an individual is authorized to practice medicine, but
that license to practise should be granted only upon presentation to a
Board of State Medical Examiners, — a diploma, — which diploma shall
be considered a sine qua non to entitle the applicant to an examination
by the Board. Incident to such a plan would be the establishment in

Reviews. — Addresses, Reports, etc.

391

every State of a Board of Medical Examiners. The Medical Society of
Virginia, impressed with the expediency and utility of such a Board for
the furtherance of medical reform, have memorialized the Legislature
of that State upon the subject. Regarding the subject in this light, the
diploma would be an academic honor, but powerless to start into actual
existence " physic and physicians" to administer to " the ills that flesh
is heir to," a sovereign balm for every wound.

As we might deter many from seeking to read the address in full,
were we to pursue it further, we shall close our remarks upon it in the
writer's own words : " And when we have our local societies, our
State societies, and the great American Medical Association, all fully
organized, all actuated by the same magnanimous impulse, and all act*
ing in united, harmonious concert, we shall present a phalanx of talent
and power and influence irresistible and invincible."

Apropos of State Medical Societies — we perceive by the Transac*
tions of the " Medical Association of the State of Missouri," to which
we now direct attention, that that body desires to have established a
Board of Medical Examiners, believing that the license law is a desi-
deratum of much moment. It is somewhat singular, that whilst other
States are just becoming convinced of the salutary effect of some pro-
tective policy, Louisiana, tolerating no restraint — no let or hindrance to
the broad and free exercise of equal rights, even though there were the
semblance of justice in the restraint imposed, has, by the concentrated
wisdom of the Legislature, medical and non-medical, decreed in favor
of no license law — a gratuity for which they will, most probably, re-
ceive the thanks of certain individuals of doubtful reputation, of assumed
medical skill and of unblushing impudence — a patrimony with which
we wish them God speed !

The Missouri Medical Association also desire the passage of a law,
" rendering any person or persons liable to indictment, conviction and
punishment at law, for selling impure, sophisticated, or deteriorated
drugs or medicines ; and that the party, when convicted, be punished
by fine, or imprisonment, or both, as the Legislature may deem best for
public security."

The Society of Missouri, in its second volume of proceedings and ad-
dresses, has published a neat pamphlet of 116 pages, giving evidence
of talent and industry.

Without making invidious distinction, we may allude in terms of
commendation to the report of Thomas Reyburn, M. D., on the domestic
adulteration of drugs and liquors; the investigations of the Committee

392

The New-Orleans Medical and Surgical Journal.

show the alarming extent to which the sophistication of drugs and che-
micals is carried on in St. Louis, as well as in the Eastern cities — exhib-
iting a fraudulent rapacity on the part of the vendor ; the profits every-
where on the sale of medicines being large, which should receive the
stigma of public condemnation, and the marked opprobrium of the pro-
fession.

Not only in the more expensive articles was adulteration detected ,
but in the writer's remarks upon vinum colchici, he observes much that
is sold "in this city (St. Louis) is almost worthless." With a view of
reforming these abuses numerous remedies are proposed, amongst
them the appeal to the Legislature, the substance of which resolution
has already been given.

The Report of Professor Charles A, Pope, on Surgery, like all the
productions of that gentleman, is characterized by much research, a
facile style of writing and a judicious selection of topics. The topical
use of water dressings in Surgery, although by no means new, is re-
garded as worthy of high consideration by Professor Pope. "Employed
either warm or cold, in its solid, liquid or vaporous state, simple or me-
dicated, it were, perhaps, not difficult to show that water fulfils a major-
ity of the indications presented in the topical management of external
lesions. In all such injuries and conditions, it well deserves the high
encomiums of being called one of the greatest antiphlogistics, and the
vulnerary par excellence."

Another subject, connected with Surgery, which is eliciting great at-
tention at the present day, comes under the consideration of the writer
— that of ovarian tumors — with regard to which, by operative interfer-
ence, such contrariety of opinion exists. " There is," it is remarked,,
" perhaps no point in surgical practice which at present produces more
excitement — some characterizing gastrotomy as nothing more nor less
than cruel butchery ; whilst others laud it as not only justifiable, but

in a majority of instances even advisable Certain it is

that modern experience has amply demonstrated the fact of the opening
of the peritoneal sac in such attempts, being much less dangerous than
was formerly supposed." L'Aumonier was the first who removed dis-
eased ovarium. Morand was also an advocate for operative interfer-
ence*

Dr. Washington L. Atlee operated in eighteen cases, and at the ex-
pense of much time and labor arranged in tabular form all the known
operations of ovariotomy, from 1701 to 1852, comprising two hundred
and twenty-five cases, including their synoptical history and analysis.

Reviews. — Addresses — Reports, etc .

393

According to his resume of cases, the rate of mortality for the opera-
tion of ovariotomy is sixty-two and a half per cent, a rate which com-
pares favorably, upon the authority of Dr. Pope, with "the other great
operations in surgery, as amputations, and the ligatures of the great ves-
sels ; the former being, by Malgaigne's computation, within a fraction
of thirty-nine per cent, and the latter, according to Norris, thirty-three
and a third per cent."

Correct diagnosis is of the last importance for the reputation of the
Surgeon ; difficult in many cases as it may be, as well as to spare the
patient the infliction of the knife, in order to discover that no tumor ex-
isted.

Vesico- Vaginal Fistula is next adverted to at some length, which,
owing to the triumph of modern Surgery, is no longer regarded as an
incurable malady; all praise is awarded to Dr. Sims, of Alabama, for
his successful labor to relieve this lamentable female complaint. As
late as the year 1846, notwithstanding the progress then made in its
treatment, it was solemnly declared by an eminent French Surgeon,
'that there did not exist in the science a complete authentic observation
of a perfect cure of vesico-vaginal fistula, dependent on a loss of sub-
stance of the bas-fond of the bladder.'

Difficulties have been overcome, and with the progress of science,
the way to successful treatment has been opened, resulting in happiness
and comfort to many deplorable patients.

There are many other reports worthy of notice in the transactions of
the Missouri Medical Association, but upon which we must withhold all
comment, lest we proceed to too great length.

" Hints to the People," as contained in Doctor Wood's publication,
is a readable little book. The medical profession and the public gen-
erally may thank the author for having spoken plainly upon subjects
touching a common interest ; his desire is to elevate the profession, and
to this end he points out existing evils, and for many of these suggests
a remedy. Having examined " systems" and "theories" with an evi-
dent dislike to be bound down by the one, or to be carried away to any
fanciful regions of exaltation by the other, it becomes the settled con-
viction of the writer, that "the entire profession of medicine may be
in accord as to certain facts, but may differ as to the general law influ-
encing the facts. The facts alone are part of the profession." And
again, " The science of medicine, then, by its very nature, by the prin-
ciples which govern the human mind, by every stimulus of interest and

394 The New-Orleans Medical and Surgical Journal.

ambition, can limit itself to nothing short of attainable truth, and it can-
not be limited by, or bound to any system. In the science of medicine
there can be no 4 old school' or 4 new school,' and the use of such terms

creates a false impression If any system or scheme sets itself

above that professional investigation which is bound to seek for truth,
and claims to be a new school or system, the claim and the pretension
are alone proof that it is not true."

The registration of births, marriages and deaths, by which many im-
portant facts connected with health and disease are made available, is
urged upon the consideration of legislators, as involving matter of great
public and national interest, no less, indeed, than the operation of moral
and physical causes upon the health and prosperity of the people. The
legislators of Louisiana, we may presume, thought differently at their
last session, upon what ground, we know not, inasmuch as they refused
favorably to entertain the subject when presented to them by a medical
gentleman of this city.

Having endeavored " to draw the distinction between the true na-
ture of the profession of medicine and the popular view taken of it,"
the author finishes by calling upon all educated classes, the pulpit and
the press, to aid in the work of medical reform. G. T, B.

|p art JTourtl).

MISCELLANEOUS MEDICAL INTELLIGENCE.

ORIGINAL.

I. — Severe Lacerated Wound of the Hand — Amputation of Several Fingers —
in which an important principle in Surgery is established.

BY J. C. HAMILTON, M.D. OF MOBILE.

A sailor, aged about 30 years, was admitted into the City Hospital for a severe
gun-shot wound of the left hand, from the bursting of an old musket, about thirty
hours before. The hand was wrapped in some rags, and a handkerchief tied tightly
around the wrist. I saw him on the morning of his admission ; he was then a good
deal prostrated from loss of blood and the fatigue of moving.

Upon examining the wounded member, it was found that the whole of the thumb
was blown off, with the exception of about half an inch of the metacarpal bone,
which was thrown back upon the wrist, entirely denuded of muscle, attached by a
small strip of skin. The metacarpal bones of the first and second fingers were found
to be completely shattered ; the wrist joint opened on the radial side, and the soft
parts extensively torn up, both on the dorsal and palmar surface. I now determined
to amputate the forearm as soon as some little reaction should be established.

After the lapse of about two hours, it then being 12 M., I returned to the Hospital,
prepared to proceed to the operation, Doctors Nott, Ketchum and Miller being pre-
sent. Upon making another examination, however, previous to operating, it was
suggested by Dr. Nott, that an attempt should be made to save the third and fourth
fingers, as they appeared to be uninjured — urging the fact that should he recover
with two fingers, they would be much more useful than the stump of an arm — that
operations had been performed at joints successfully ; and even should it be necessary,
(as his constitution was a good one) the amputation could be performed above at a
future period. In view of these considerations, it was determined to make the attempt.
The chloroform was now administered by Dr. Miller ; acting perfectly, the patient
coming under its influence in a few minutes, and remained sleeping as quietly as an
infant throughout the operation, which was an exceedingly tedious and troublesome
one. The operation was now commenced, Doctors Nott and Ketchum assisting.
Two flaps were made, one on the dorsal and one on the palmar surface, from as
much of the skin and flesh as was apparently sufficiently sound for the purpose, the
incision commencing at the phalangeal articulation of the second finger, extending
in a semicircular direction to the lower extremity of the radius ; the flaps being held
back, the metacarpal bones of the two first fingers were disarticulated at the carpus "5

396

The New-Orleans Medical and Surgical Journal.

when it was found that the bones of the medial side of the carpus, and the metacar-
pal bone of the third finger were comminuted. The flaps were immediately extended
and the ring finger also disarticulated, and the fragments of the carpal bones extract-
ed piece by piece, consisting of pieces of the scaphoid, and the whole of the trape-
zium and trapezoid.

The hemorrhage was trifling, it being necessary to tie only one vessel, the poste-
rior carpal ; some small branches sprung, but they were easily controlled by tor-
sion.

The wound was now closed ; the flaps being brought together and retained by su-
tures— this being sufficient to cover the wound only partially, the long surface, how-
ever, being well covered and the wound dressed with dry lint and the uniting band-
age.

The patient did well, no unpleasant symptoms occurring at any period. The
wound healed more kindly than was expected, covering the long surface by the first
intention, leaving only for treatment a granulating portion, which also healed kindly.
In a little more than a month the wound was entirely closed and the patient dis-
charged.

1 have frequently seen the patient since at my office, entirely well, and gradually
gaining some motion in the remaining finger. He is now, I believe, acting as watch-
man on one of the river boats.

The chief point of interest in the above case is the fact of the possibility of such
an extensive operation being performed at the wrist joint, without bad effects, and the
possibility thereby proved of saving, in cases of extensive injury of the hand or foot,
portions that may be much more serviceable in after life than a bare stump. Two
fingers or even one finger, as in this case, are certainly much more useful than a
naked stump. It is merely one more case illustrating the importance and utility of
attempting to save as much of an injured limb as the circumstances of the case
will possibly allow.

September, 1852.

II. — Chorea Cared by Strychnine.

Prof. Forget we believe was the first (says the Journal des Connaiss. Med. Chirurg-
for July and August, 1852) to direct the attention of the profession to the efficacy of
strychnine in the treatment of chorea; and recently Dr. Landrel, in a communication
to the Redacteur of the above Journal, reports a violent and threatening case of cho-
rea, which was speedily relieved by strychnia. He relates the case as follows : The
little village of Montreal, in France, was suddenly thrown into great commotion last
January, by the rumor that a very strange disease had seized a little girl, 12 years of
age. She could do nothing, said the people, but dance and make hideous faces ;
that she was, in fact, possessed of the devil. On visiting the patient, the mother of
the little girl remarked to the doctor, with tearful eyes, " My daughter is folle —
crazy ; she does nothing but dance from morning until night ; she is unable to stand
upon her legs, and must be held in her bed." It turned out to be a severe case of

Miscellaneous Medical Intelligence. 397

chorea, induced by the father attempting to strike the child. The girl was of a ner-
vo-lymphatic temperament ; delicate, a blonde, with blue eyes and feeble muscular
power.

The chorea involved all the muscles, which were unceasingly in motion, except
when asleep. When raised she could neither walk nor stand, nor could she pro-
nounce a word. Her head was constantly thrown back, and her features were dis-
torted. The author goes into full details of all those symptoms which constitute a
well-marked case of chorea. He ordered cold aspersions, and one centigramme of
powdered belladonna, on the 19th January ; and on the 20th the same symptoms
persisted ; deglutition had now become difficult, and food fell from her mouth as she
attempted to take it. By throwing cold water over the face, as recommended by
Simpson, she was enabled to take a little soup. The affusions were now repeated,
and the dose of belladonna was augmented to 2 centigrammes. On the following
day acute bronchitis supervened, when the cold water was suspended and the bella-
donna was continued.

By the 26th the patient was a little better, and after this date up to the 28th of
February, she remained stationary, although the same treatment was continued; but
at this time she had neither power to walk nor to speak. At this stage of the case,
despairing of effecting a cure by the means already in hand, Dr. L. began to give the
syrup of strychnia in coffee spoonful doses, three times daily the first three days, and
afterwards twice per diem. On the sixth day from the commencement of this treat-
ment, the patient was enabled to walk and pronounce a number of words ; and on
the eighth day she perfectly recovered her speech ; and on the twelfth day of the
treatment by strychnine, she was perfectly cured.

In concluding this article the author observes, that the strychnine given in the pre-
ceding case did not produce the slightest convulsive twitchings ; there being neither
rigidity in the muscles of the neck or jaws. During the treatment, the patient took
in all only five centigrammes, and this might seem to justify some doubts as to the
efficacy of the remedy ; but when it is remembered that the disease was and had
been for sometime stationary, before the strychnine was given, and began soon after
this medicine was ordered to improve rapidly, all doubt on this point must be at
rest.

The disease continued about two months, and during seven weeks of this time
she could neither walk nor speak.

III. — Cauterization of the Lobe of the Ear a Cure for Chronic Rheuma-
tism.

It has already been reported through the medical press of this country, that cau-
terization of the lobe of the ear is an instantaneous cure for sciatica ; but we can
now go one step farther, for it appears from the following facts, reported by a French
physician — M. Henry — that he was induced to try the same means, and to his aston-
ishment with success, for the relief of chronic rheumatism. A man, whose age is
not given, had suffered for five years with this disease in his right arm ; the pains
were deep-seated, and almost insupportable. Mr. Henry had resorted to all the reme-

398 The Neic -Orleans Medical and Surgical Journal.

dies recommended in such cases, but without success. Says M. H., when I proposed
to burn or cauterize a certain spot on his ear. he laughed at me. He, however, con-
sented ; and great was his astonishment, when, at the end of four days, the pains
in the arm entirely ceased ! This cure, he proceeds to observe, was reported over
the country, and in a few days afterwards Michel Boda of M * * * applied to me,
and requested to be treated in the same manner for a rheumatism in the left arm.
He was subjected to a similar treatment, and with a success equally prompt and de-
cisive. With these facts before us, continues M. H., I ask how are these cures ef-
fected? Here he proceeds to trace the course of the great sympathetic nerve, which
arises from the superior cervical ganglion, he remarks, behind the ear, and after hav-
ing traversed the thoracic and abdominal cavities, then becomes confounded with
the sacral pair, whence proceed the nerves of the inferior extremities.

IV. — Excessive Obesity removed by Tincture Iodine.

In the Medicinisches Correspondenz -Blatt, Dr. Betz reports a curious fact re-
garding the efficacy of tincture iodine in obesity. A female aet. 49, uniformly regu-
lar, had complained for three years of pains in her breasts ; these glands, at the same
time, were so large, that they descended as far as the hypochondriac region, and the
abdomen had likewise grown so large that the woman could neither stoop nor attend
to her domestic duties. There also existed patches of fat under the axilla and on
the back. The limbs remained natural. M. Betz placed this female upon the use
of tincture iodine, of which she took 20 drops daily. Speedily the fat began to dis-
appear,— so rapidly indeed, that at the end of two months this woman was reduced
to her usual degree of embonpoint and natural size. Will some of our readers, to
whom applications may be made in such cases, test the tincture of iodine?

(Ed.)

V. — Acetic Acid as an application to Primary Venereal Chancres.

Some French Surgeons, and among the number MM. Ricord and Henrotay, speak
in high terms of the virtues of acetic acid as a local application to venereal ulcers in
the primary stage. The former of these believes that acetic acid neutralizes the ve-
nereal poison, and thus obviates all danger of secondary or constitutional symptoms.
It may be applied as any other caustic, and repeated as frequently as the condition
of the chancres may require. Under its application the ulcer speedily assumes a
healthy aspect and promptly cicatrizes. (Ed.)

Miscellaneous Medical Intelligence.

899

VI. — Injections of Acetate of Lead in Chronic Cystitis.

The following formula has been highly extoled as an injection in chronic diseases
of the bladder :

^ Aqua Distil. 192 grammes.

Mucil. Gum. Arab. 16 "

Acet. Plumb, (cryst.) 50 centigram.

The injection must be repeated several times ; and at each sitting from 32 to 64
grammes of the liquid must be allowed to remain iu the bladder from five to ten
minutes. The injections must be repeated every second day for one or two months,
selon la gravite de la maladie. {Ed.)

VII. — Chloride of Sodium in Intermittent Fever.

Several of our " Exchanges" speak of the efficacy of the chloride of sodium in
the cure of intermittent fever ; but the most elaborate and carefully prepared paper
on this subject is from the pen of Dr. Lattemore, and may be found in a late number
of the American Journal of the Medical Sciences. In this essay Dr. L. details the
method pursued by M. Piorry — his extreme tact in detecting enlargement of the
spleen — his success in reducing this organ by the use of chloride of soda. Most of
the cases of intermittent fever met with in the Parisian Hospitals are of long stand-
ing and imported from Algiers, says Dr. L., and they are always accompanied with
enlarged spleens and difficult to cure. " We witnessed," says this writer, "many of
the experiments of M. Piorry, and in the great majority of cases the fever yielded to
salt quite as readily as to the salts of quinia." M. Piorry's method of administering
the chloride of soda is, to give half an ounce in a cup of thin soup during the apyrexia
and fasting. It generally agrees with the stomach ; rarely purges or vomits. Three
doses usually suffices to effect a cure.

It seems to be particularly applicable to cases attended with enlargement of the
spleen, which is readily diminished in size, after the first dose of the salt is taken into
the stomach. From all we can glean on this subject, we are persuaded that the
chloride of soda will cause a reduction in the dimensions of the spleen, particularly
if the hypertrophy of this organ be the result of exposure to malarial influences. We
consume, perhaps, two ounces of salt daily at dinner, and although we have been
exposed for years to the so-called malarial influences, yet we have never suffered
from an attack of intermittent fever ! Let the profession investigate this subject
and make known the results. (Ed.)

400 The New-Orleans Medical and Surgical Journal,

VIII.— Treatment of Typhoid Fever in the South.

In the September No. 1852 of the Charleston Medical Journal, Dr. Douglass
gives the profession his experience in the treatment of typhoid fever. It will be per-
ceived that he condemns the use of quinine in this disease, toto coelo, and thus tilts
against the views of one of our much esteemed correspondents. Hear Dr. Douglass
tell his 40 years experience in the treatment of continued fever. {Ed.)

My own plan of treatment is expectant ; and in the few remarks I shall make?
they will be of rather a negative character, and intended to guard against the use of
remedies which I know to be injurious, rather than to lay down ally fixed plan or
course of treatment.

In the first place, I never have recourse to quinine. I have, again and again,
met the disease at the threshold, when it appeared to wear the livery of an intermit'
tent, the patient appearing lively in the morning, and having no symptom of fever,
but during the day complaining of slight chilliness, lassitude, and threatening symp-
toms of a regular chill, followed by pain in the head and other parts, and fever, which
would go offinthe course of the night, leaving the patient, as above described, in the
morning. This train of symptoms frequently continued for several days. Under
these circumstances, I have had recourse to every plan I could devise, for the purpose
of ;< breaking up" the disease before it should be fully developed; but invariably with
disappointment to myself, and, I believe, frequently with increased suffering to the
patient. In my practice, quinine, given in doses large or small, and in every form, in
no single instance arrested the disease, but often increased the irritability of the sto-
mach, the pain in the head, and every symptom connected with the fever. I have
long since abandoned it as absolutely pernicious.

In regard to purgatives, they, like blood letting, have no salutary control over the
disease, but prostrate the patient more rapidly, and always tend to protract convales-
cence. There are some cases, particularly among white patients, in which the ap-
plication of a few leeches or cups to the head, nape of the neck, epigastrium, etc.,
according to circumstances, will exert a decidedly happy influence. But such cases
are rare, and among plantation negroes, will scarcely ever occur. When there ap-
pears to be no local determination, the excitement equally diffused, the skin hot and
dry, and the pulse quick and somewhat tense, sponging the body with cold water, dur-
ing the first few days, will generally produce a beneficial result. In cnses where the
patient is restless, with a hot, dry skin, and the head, stomach, bowels, or kidneys
appear to be suffering, the warm bath will usually add greatly to the comfort of the
sick. Warm fomentations, and poultices to the stomach and bowels, and sinapisms
to the forehead and back of the neck, will often relieve pain and uneasiness in those
parts, and should be continued as long as they appear to do good. But if they fail to
afford prompt relief, I apply blisters, without waiting for symptoms to determine "the
blistering point.'' In many cases, where the patient is harassed, day after day, with
a deep-seated pain in the head, above and behind the eyes, attended with intolerance
of lio-ht, etc., the application of a blister to the forehead, extending from temple to
temple, gives instant and permanent relief. When the stomach is affected, either
with pain, soreness or nausea, I always blister in the early stages of the disease, and
also when it is spending its force on the bowels, and invariably with good effect. Cold
water, with or without gum acacia, may be allowed freely throughout the attack. I
have long since given up the mercurial plan of treatment, though 1 would not object
to a few small doses of blue mass at the commencement. But castor oil. calcined
magnesia, or enemata, will be found to answer every indication, when laxative me-
dicines are required, which is seldom. When the bowels act too freely, morphine,
McMunn's elixir, or other opiates, are preferable to any astringents. I have some-
times observed very decided improvement after alarming hemorrhage from the bow-
els. In protracted cases, where the strength and vital powers of the patient are
greatly exhausted, and a stimulant is required, the carbonate of ammonia, or spiritus
mindereri, when it does not nauseate the stomach or irritate the bowels, answers a
very good purpose; but if it produces the latter effects, it should at once be discon-
tinued. Brandy, when a stimulant is indispensable, is preferable to all others. But

Miscellaneous Medical Intelligence,

401

few cases will need active stimulation, unless the powers of life have been wasted
fey too active treatment at the commencement of the disease.

To conduct a patient safely through an attack of typhoid fever, the physician
should economize the recuperative energies and strength of the sufferer from the be-
ginning. As it is impossible, so far as we are acquainted, to break up" the disease
by active remedial agents, we should avoid them, and commence with rather a tem-
porizing routine of remedies, to be administered as exigencies demand ; in a word,
we should do but little. I would infinitely prefer giving nothing but cold water and
thin gruel, and applying blisters over the parts affected, and doing nothing else, to
resorting to the vigorous, heroic attempts to arrest typhoid, as we would intermittent
or bilious fever. I am satisfied that in this affection, as in scarlatina, the mortality
has not been lessened by efforts to stay its course.

I was taught, in my pupilage, by the venerated Rush, that there was a time to sti-
mulate, a time to deplete, and a time to do nothing, and my long experience in ty-
phoid fever has convinced me, that in very many cases, the last alternative is far pre-
ferable to an energetic prosecution of either of the former.

IX.— Starch in Cutaneous Diseases,

That distinguished Dermatologist, M. Cazenave, has recommended the fol-
lowing formula as an external application in the annexed list of acute diseases :
Acute eczema, impetigo,herpes, acne rosacea, prurigo of the axilla, anus, geni-
tal organs, etc.

This is the prescription to be used after washing the parts in a weak alka-
line solution :

Take of oxide of zinc -one part ; powdered starch fifteen parts ; mix, and co-
ver the affected parts thoroughly with the powder. A small portion of pow-
dered camphor may be added to the mixture with decided benefits where much
pruritus exists.

X. — Nitric Acid in Hooping- Cough and Asthma.

Br. Anoldi (Canada Medical Journal) extols the use of nitric acid in hooping-
cough, at all ages— whether it be a child at the breast or a full grown adult (!)
— in either condition of life its virtues, he declares, are unquestionable and
prompt. He gives the nitric acid in solution, as strong as lemon juice, sweet-
ened ad libitum. He brings forward a number of cases in which the disease
was not only promptly mitigated by the nitric acid, but all of them shortened
at least one half the usual period required to exhaust itself.

Some of the Physicians of New Orleans, and among the number Dr. Fenner,
has tried the nitric acid in asthma, and with very satisfactory results in a few
cases. (Ed.)

402

The New-Orleans Medical and Surgical Journal.

XI. — Practical Chemistry a Branch of Medical Education — Considered in a
Brief Letter tohis Class.

BY ALFRED L. KENNEDY, M. D., PHILADELPHIA.

Dr. Kennedy is, we believe, the first medical gentleman who has attempted to es-
tablish a Laboratory in this country to teach Medical Chemistry. This letter, which
seems to be addressed to his class, sets forth in strong and appropriate language the
claims which this branch of Medicine have upon the student and the profession. He
compares the course of Medical Chemistry as taught in the United States with the
same branch of the profession as pursued in Europe ; and of course the odds are im-
mensely against us, as in every thing pertaining to medicine.

Dr. Kennedy closes his instructive letter in the following language :

Finally. Your correspondent, after a careful and impartial comparison of Euro-
pean colleges with our own, knows no requisite to graduation (save hospital attend-
ance) in which we are so deficient as in that of Chemistry. How much of that defi-
ciency has arisen from a want of practical skill on the part of those who have held
the position of chemical professors, it would be out of place here to inquire. Unfortu-
nately, the general ignorance of this science in other walks of life, creates a more
absolute reliance upon the physician, and compels a more frequent reference to him.
Verily, in no other enlightened land is so much required of the practitioner as in ours.
Especially in rural districts, is his head supposed to be a treasury of all knowledge, and
many and varied are the drafts upon him, be it in the examination of a pustule or a
mineral ; in tasting a porridge or testing a medicinal spring ; in a case of labor or one
of suspected poisoning. Should he not honor his clients drafts at sight, alas for the
reputation of our village doctor I

Jealousy of innovation, which, properly maintained, is the safeguard of medical
teaching, as it is of medical practice, will demand much proof before any change is
determined on. This we must always be prepared to furnish. Jealousy of dictation,
which is characteristic of our people, actuates also our profession, and however ear-
nestly the introducer of any salutary measure may advocate it, unless the mass which
surround him, and who have witnessed his success, second his appeal, it falls un-
heeded on the public ear. To you, then, who have enjoyed and acknowledged the
value of laboratory practice, will the profession look for testimony in its favor.

Let us, then, continue earnestly and respectfully to call the attention of professors,
laity and students, to the exalted position which chemistry occupies among her sister
sciences, and to the imperative necessity of studying it both theoretically and practi-
cally, if one would grasp and retain its great teachings. In things commercial, Ameri-
can earnest energy is universally acknowledged ; but the sneering expression is still
not unfrequently heard on the continent of Europe, " l'Amerique n'est pas grand
chose en rapport avec la science." Let us prove this destitute of even seeming founda-
tion, by the most thorough cultivation of that3 which is emphatically the leading sci-
ence of the nineteenth century.

XII. M. Racemier — His death — Honors paid to distinguished Medical Men

in France.

M. Racemier, Physician to the Hotel Dieu, Ancient Professor to the Faculty of
Medicine and the College of France, Member of the Academy of Medicine, expired
suddenly of pulmonary apoplexy on the 28th of January, 1852. The funeral of the
illustrious Professor took place on the 1st of July with great pomp. In the funeral cor-

Miscellaneous Medical Intelligence.

403

tege the Faculty was represented by MM. Adelon, Cruvielhier,Bouillard, Trouseeau,
Moreau, Requin, Malgaigne, Nelaton, Denonvilliers, etc. ; the Academy of Medicine
by the President, M. Dubois, and its Annual Secretary, M. Guibert. Besides these,
a large number of the most renowned Physicians assisted at the funeral obsequies.
The desire to pay homage to the memory of the deceased was not confined to the itfe-
dical profession ; for some of the most illustrious political characters of France were
in attendance — such as Pastoret, Berryer, General of Saint Priest — of Narbonne — of
Renneviile, Poujoulat ; and also Profs. Then ard, Binat, Cauchy, de Portels and Oza-
nau.

At the cemetery of Mount Parnassus, wherein the body was entombed, four eulogies-
were pronounced over the tomb of the distinguished dead. These orations recounted
the achievements and the services which Racemier had rendered to science and to hu-
manity. They were eloquent and lofty in their tone and spirit. France well knows
how to reward the labors of her distinguished sons during their lifetime, and to conse-
crate their memories and their services after their death. Vive, la belle France.

Ed.

XIII. — Resuscitation from an overdose of Chloroform.

The American Journal of Medical Sciences contains the following hints by
Dr. Herepath, on the subject of poisoning from chloroform.

In resuscitating from an overdose of chloroform, galvanism is the only chance.
Keep up a current of electricity through the fifth nerve, medulla oblongata,
phrenic nerves, and diaphragm, as long as respiratory movements can be pro-
duced, and let the patient have plenty of fresh air or oxygen gas, and the„case
must do well, for the blood must remain fluid for a long time, and circulation
will go on as long as respiration continues to go on artificially. The blood and
the air cells throw off their load, and in proportion as the pneumo-gastric, me-
dulla oblongata, and motor nerves, slowly resume their functions, so respiration
begins to assume a less artificial character ; at length the cerebrum aids us, and
respiratory movements, both voluntary and involuntary, keep up the functions^
of life unaided.

XIV. — Hooping- Cough cured by Cauterization of the Glottis.

A new method of treating that intractable disease, the hooping-cough, has-
been lately brought forward by M. Joubert. Out of 98 cases treated by cau-
terization, (30 of which M. Joubert rejects as unworthy of reliance) the re-
maining 68 were divided into three series, according to the periods at which
the treatment was commenced. Of these 40 were rapidly cured, 21 experien-
ced marked relief, and in the remaining 7 cases the treatment failed to confer
any benefit whatever.

404 The New-Orleans Medical and Surgical Journal.

XV. — Treatment of Typhoid Fever — It must be modified to suit the locality,

Typhoid fever, so called, is engrossing much of the attention of Practitioners
throughout the South and South-west ; nor is this surprising, when in nearly
every Medical Journal, issued in these latitudes, we find speculations as to its
communicability, treatment and identity or non-identity with the various forms
of marsh or malarial fever. Judging from observation, some little reading and
the letters we receive from almost every section of the South, typhoid fever
has become the prevalent disease, and threatens at no very remote period to
absorb all other forms of fever. In view of these lacts, we feel constrained to
lay before our readers all the information we may be enabled to glean on this
interesting subject. To this end, we invite their attention to an instructive ar-
ticle in the October number of the Southern Medical Journal, from the
pen of Dr. Wilburn.

After contrasting the symptoms of typhus and typhoid fevers, and showing
the non-identity of the two diseases, Dr. W. proceeds to detail his method of
treating typhoid fever. We shall sum up in a few words (as his article is too
long to be inserted entire) the main points in his paper. He condemns bleed-
ing from the arm, as it always kills in East Alabama. Quinine he proscribes
in toto, in every stage of the disease ; it has always proved detrimental in Dr.
W.'s hands. Blisters do more harm, as a general rule, than good. He recom-
mends us to maintain a cheerful spirit in the breast of the patient, as it assists
in restoring and maintaining the powers of the system.

From the foregoing sketch, the reader will observe, that Dr. W., who has
had much experience in this disease, condemns venesection, quinine and blis-
ters, as therapeutic agents in typhoid fever. He says, he varies the treatment
to suit the wants of each particular case. He treats, in a word, "symptoms
rather than a name.55 Then why condemn bleeding, quinine, blisters, etc., in
" typhoid fever ?" Suppose the symptoms should call for one or more of these
agents, they must not be brought into requisition because it chances to be a
case of typhoid fever, and these have been condemned in this disease ! What
of such reasoning? But we pass on. When called to a case, Dr. W. gives
10 grains of calomel or 15 of blue mass ; this is worked off by soap and water
injections, assisted by a saline cathartic in ten or fifteen hours. He urges the
free and frequent use of enemas in typhoid fever, and declares they exercise a
soothing effect upon the nervous system, if given at night. Here we let the
Doctor speak for himself. Ed.

After a free evacuation of the bowels, I administer the following powder
every four hours :

Should the pulse be quick, I do not hesitate to give the veratrum viride. To

season, etc.

Hydr. Sub. Mur.
Ipecacuanha,
Pulv. Doveri,

grs. m
grs. ii
grs. v

•

Miscellaneous Medical Intelligence.

405

an adult, I commence with six drops (Norwood's) in about half a fluid ounce
of sweetened water — in ten minutes seven drops; in ten minutes more eight
or ten drops, and wait the result, which is free emesis, a reduction of the
pulse, a soft skin, and gentle perspiration. I then continue the veratrum, giv-
ing six drops (the first dose) in four or five hours, and increasing one drop every
four or five hours until ten drops are reached ; I then continue ten drops every
six hours, and gradually increasing the period to twelve hours. Some patients
cannot reach ten drops ; in such cases, the practitioner should stop at that
number which produces emesis, and falling one drop below it, continue the
dose every six hours, and gradually extend the period.

The veratrum should be followed in every instance by free drinks of slippery
elm or gum arabic water, as also by the following powders, every two hours,
extending the time as the period of the veratrum is extended.

Ipecac, grs. ii

Dover's, grs. iv

I speak from experience when I recommend the veratrum viride to the pro-
fession. I am as much opposed to nostrums as any one, but l do think that
when a medicine has been suggested to the profession which answers a deside-
ratum— might I not say, wipes away an opprobrium medicorum — it is but jus-
tice— it is but a just regard to the high and noble claims of science, that it
should be fairly tested. I have derived the most flattering results from its use,
and as yet have seen nothing in its action to induce me to discontinue it. I
am no enthusiast of any remedy, and would by no means pen one line concern-
ing any drug, which might induce practitioners to essay its virtues at the im-
minent peril of their patients. That the veratrum controls the action of the
heart, is beyond question, and that this was a desideratum in medicine, is
equally undeniable. The digitalis has hitherto been employed for this purpose,
but that it is uncertain and even dangerous in its action, is known to every one
who has used it. It frequently proves powerless, and not unfrequently, like a
cowardly giant, watches the auspicious moment when it may exert its feigned
prowess upon a helpless and prostrate victim.

The veratrum, when properly administered, is certain in its action, and does
not, like the digitalis, apparently sleep until it has gathered sufficient force to
storm and overpower. 1 have employed the veratrum in other diseases beside
typhoid fever. Pneumonia, pleuritis, puerperal peritonitis, palpitation of the
heart, and the convulsions of children, and in all with signal benefit to the
patient.

It is objected that the veratrum inflames the alimentary canal. This it will
not do if given as I have advised. I should state, however, that I use the elm
bark fresh from the tree, and not a worm-eaten ground Indiana elm. They
who complain of its irritating qualities, gave it, probably, too frequently, or
without water, or an impure preparation. I have administered the medicine
in numerous instances, and attempted to watch closely its effects, and never
yet have I observed the results spoken of by other physicians. It sometimes
produces stupor in children, resembling approachnig coma, but if continued
until emesis is brought about, this symptom speedily disappears.

I have been told by some practitioners that they considered the veratrum a
humbug, and never gave it. Such have set aside a valuable remedy, and wor-
thy to be tried, and as it is not yet too late, I say, try it.

Some, on the other hand, are fearful to use it. These individuals give fre-
quently a more dangerous medicine — the digitalis purpura. I have written
more upon the veratrum than I at first intended; but should what I have writ-
ten prove effectual in inducing practitioners to try the virtues of this medicine,
1 shall *feel amply compensated for my labor.

406

The New*Orleans Medical and Surgical Journal.

After evacuating the bowels, the use of the compound powder, the veratrum,
injections, etc., as described, I cup and scarify the epigastrium and right iliac
fossa. I then order a poultice of corn meal and Cayenne pepper to be applied
over the bowels every hour, with sinapism to the spine. Should the poultices
not prove sufficient to allay abdominal heat, I put on a sinapism over the bow-
els to remain ten or fifteen minutes, and re-apply the poultice. This sinapism
should be repeated every six or eight hours until the heat of the surface is sub-
dued. The poultices and injections should be kept up during the whole course
of the disease. The injection should be given at least once, if not twice, every
day. The kind of enema must vary according to circumstances — such as
warm water; salt and water; warm water, laudanum and starch ; acet. plumbi,
and nit. argenti, etc. These, as many other things, depend upon the judgment
of the physician. As a diaphoretic, tonic and diuretic, I use the seneca and
spirits nitre ; a free drink of the former, and teaspoon doses every three or four
hours of the latter.

In severe cases, I blister the entire spine and give ice freely. There are
many opposed to the use of ice ; more especially those of the Vulcan school.
Some cases no doubt die, where ice has been used; but should it be rejected
because a few die under its use ? This does not prove that ice was the cause
of the death. Calomel is given, and the patient dies; do you then reject it
from your practice ? And so we might say of any medicine ; patients die un-
der the best treatment.

In low muttering delirium, the ice applied freely to the scalp, and given in-
ternally, in pieces, to dissolve in the stomach, will, in nine cases out of ten,
arouse them to rationality. I write what I have seen at the bedside. It re-
lieves the heat and distress of which the patient so frequently complains whilst
racked by the fever. It should be given in as large pieces as can be readily
swallowed. I sometimes give lemon water with ice, but do not order a free
drink of any iced water. Its solid state is the best state in which it has been
administered. Applied in iced bags or bladders to the abdomen, and given
freely internally, it is our sheet-anchor (I speak positively) in dangerous in-
testinal inflammation. I know that there is a prejudice with many of the pro-
fession, so deep and lasting against the use of ice and cold water, that they
will not credit the treatment of any one who embodies them among their the-
rapeutic agents. Such men add but little to the progressive march of medicine;
they dare not step one side an old and routine practice for fear of committing
an error ; they err in being too cautious, and condemn because they do not ex-
periment. I do not intend to say that practitioners should experiment upon the
lives of their patients — far from it ; but I do say, that when life is fast failing,
the physician should do all in his power to save it, and if his usual remedies
prove powerless, he should try others which have been highly recommended.
Short of this, he does not perform his duty.

I have now given a short and very imperfect sketch of my treatment in ty-
phoid fever. I have not thought it proper to write the varied changes which
are so often observed in this fever, preferring to leave the treatment of them to
the judgment of the physician, as no two cases will be precisely alike, but va-
ried in their progress by constitution, habit, vicissitude of weather, etc. My
purpose has been to discuss plainly and consisely that form of treatment which
I believe to be most successful in typhoid fever. I wish also to be understood
as speaking of this locality; for I write from experience in this place alone,
and do not by any means attempt to dictate to any one ; but should what I
have written attract the attention of any member of the profession, and "ena-
ble him hereafter to diagnosticate correctly, and to treat the disease success-
fully, I shall feel amply rewarded for the little toil it has cost me to write this
article, and feel too, at the same time, that I have done the profession some
service."

Miscellaneous Medical Intelligence.

407

Dr. Wilburn makes an addendum to his valuable paper, in which he states,
that as there are many who do not believe in the existence of typhoid fever as
a distinct disease, he proposes as follows — to which we invite the attention of
the profession :

1st. That physicians of Georgia, Alabama, Mississippi, Florida, Louisiana,
and Texas, report their names to the New Orleans Medical and Surgical Jour"
nal and the Southern Medical and Surgical Journal of Augusta, as either for
or against typhoid fever, as a separate and independent disease.

2d. That as many as can find it consistent with their labors, write out their
views as to its independence or identity with other diseases, and the treatment
found most successful.

I believe that every member of the profession is honest in his opinion ; but,
if possible, we should know the truth of the matter. If there is any
hope of settling these vexed questions, let it be done before they are pushed
upon another age. We are probably as well prepared to discuss the identity
or non-identity of typhoid fever now as we will ever be. Many consider it a
modification of remittent fever — some of intermittent — some as identical with
typhus. It would be proper for these to state what they consider remittent, in-
termittent and typhus fever, and further, to relate clearly the nature of that mo-
dification which gives rise to those peculiar symptoms known to many as ty-
phoid fever.

I wish to see an interest manifested in the profession in diagnosis, not only
in typhoid, but in every other type of fever. If typhoid be remittent or inter-
mittent fever, its treatment is clear ; if not, its nature should be ascertained,
that it may be properly treated. I should be pleased to see a table of physici-
ans' names, as to identity or non-identity of this fever, and in that table I shall
risk my name as to its non-identity, and in favor of the doctrine that it is a dis-
ease sui generis.

I am fully aware of the incoherency of this article, written at many sittings,
caused by professional duty. This, however, could not be avoided, and should
it not meet with approbation, I have the consolation to know —

" Nec semper feriet quodcunque minabitur areus."

XVI • — Binocular Microscope.
From the Transactions of the Phys. Med. Society of New Orleans.

At a meeting of the Physico-Medical Society, on Saturday evening 2d Octo-
ber, Prof. J. L. Riddell called the attention of the Society to an instrument of
his own invention and manufacture, which promises to be of incalculable ad-
vantage in microscopic researches, especially in the prosecution of microsopic
anatomy and physiology.

He remarked, that he last year contrived, and had lately constructed and
used, a combination of glass prisms, to render both eyes serviceable in micros-
copic observation. The plan is essentially as follows :

Behind the objective, and as near thereto as practicable, the light is equally
divided, and bent at right angles and maie to travel in opposite directions, by
means of two rectangular prisms, which are in contact by their edges, that are
somewhat ground away. The reflected rays are received at a proper distance
for binocular vision upon two other rectangular prisms, and again bent at right

408 The New-Orleans Medical and Surgical Journal

angles, being thus either completely inverted, for an inverted microscope, or
restored to their original direction. These outer prisms may be cemented to the
inner, by means of Canada balsam ; or left free to admit of adjustment to suit
different observers. Prisms of other form, with due arrangement, may be
substituted.

This method proves, according to Prof. RiddelPs testimony, equally applica-
ble to every grade of good lenses, from Spencer's best sixteenth to a common
three inch magnifier, with or without oculars or erecting eye-pieces, and with
great enhancement of penetrating and defining power. It gives the observer
perfectly correct views in length, breadth, and depth, whatever power he may
employ ; objects are seen holding their true relative positions, and wearing their
real shapes. In looking at solid bodies, however, depressions sometimes ap-
pear as elevations, and vice versa, forming a curious illusion ; for instance, a
metal spherule may appear like a glass ball silvered on the under side, and
the margin of a wafer may seem to ascend from the wafer into the air.

With this instrument the microscopic dissecting knife can be exactly guided.
The watchmaker and artist can work under the binocular eyeglass with cer-
tainty and satisfaction. In looking at microscopic animal tissues, the single
eye may perhaps behold a confused amorphous, or nebulous mass, which the
pair of eyes instantly shape into delicate superimposed membranes, with inter-
vening spaces, the thickness of which can be correctly estimated. Blood cor-
puscles, usually seen as flat disks, loom out as oblate spheroids. Professor R.
asserted, in short, that the whole microscopic world could thus be exhibited in
a new light, acquiring a ten-fold greater interest, displaying in' every phase a
perfection of beauty and symmetry indescribable.

Sulphat. Bebeerine.

Prof. Nott stated that he wished to call the attention of the Society to a re-
medy, which, although introduced as early as 1843, (mentioned by Dr. Rodie,
in 1835) had never come into general use : Bebeerine, or rather the sulphate
of that alkaloid. He had been using it pretty extensively for the last two
months, principally in hospital practice, and was well pleased with its effects
in intermittent and remittent fevers, and in some of the neuralgias. He believed
it to be a better tonic, to possess more astringency, and, as far as he had ex-
perimented in those diseases, to produce equally as prompt antiperiodic effects
as the sulphate of quinia. He believed it to be better adapted to those persist-
ent cases of intermittent so common in our Southern latitudes. For its tonic
and antiperiodic effects, he had used it in the dose of four grains every three
or four hours, dissolved in water ; in the so called abortive treatment, in the
dose of one scruple ; in well marked quotidian or tertian, he had not failed in
a single instance to prevent the chill by administering 20 grains immediately
before the expected paroxysm.

Arsenic, though a valuable, was a dangerous remedy at all times, even in
the hands of the most careful, and when long continued, not unfrequently pro-
duced permanent injurious effects.

He intended to continue his experiments, and give more fully the result of
his observations. He only desiied to mention the subject at present, that
other members of the Society might be induced to assist him in the inves-
tigation.

The best varieties of the Cinchona tree, it was feared, might at no distant
day become, if not distinct, at least very scarce, as no means of propagating

Miscellaneous Medical Intelligence.

409

them has as yet been successful, and it behooves us to look for some substitute
for this invaluable drug.

The Greenheart (Nectandria Rhodeicei) was a large forest tree (Bebeeru, of
the natives) indigenous to the British Guiana, and extensively used in ship
buildino-. Both the bark and the fruit are rich in Bebeerine, and these, unless
a market could be induced, would be discarded as worthless. Should it be
found to answer the purposes claimed for it, the alkaloid might be obtained at
a trifling cost.

The tree contains a second alkaloid, Sipeerine, which, as far as he knew,
had not been experimented with.

He had in some instances known it (Bebeerine) to produce irritability of the
stomach, (on which account it had been objected to by some) but he had known
sulphate of quinine to produce it quite as often.

(iV. O. Monthly Med. Reg.)

XVII. — Professional Letters from Paris — Velpeau — Chomel — Hotel Dieu —
Nelaton — Civiale — Roux.

Our distinguished countryman, Prof. P. F. Eve, has been spending the pre-
sent season in Europe, in close communication with the medical savans of Pa-
ris and other large cities of the old world. During his absence, he addressed
the following letters to the Editor of the Nashville Medical Journal, which will
be read with pleasure and instruction by his friends.

(Ed. N. O. Med. Jour.)
Paris, May 25, 1852.

Dear Doctor — I arrived here safe on the 21st, and soon met our friends, Prof.
Lindsley and Drs. Duval, Breckenridge and some others, who, like myself, have
been attracted to this head quarters of medical science. I find our colleague
labors in the laboratory nine hours a day.

1 have only as yet visited La Charite and shaken hands with the great Vel-
peau. He has but little of much interest in his wards. I saw him divide the
tendon of the tibialis anticus muscle and operate for cataract. He has one cu-
rious case, to which he specially directed my attention. This is a salivary fis-
tula, situated about three quarters of an inch behind the angle of the inferior
maxiliary bone, in a young man of 19 years. He says he had an abscess in
the parotid region, which was open seven years ago, and this fistula is the re-
sult. The peculiarity of this case is in its position, so distant from the canal of
Steno.

In his lecture of this morning, he dwelt upon the therapeutic effects of tinct.
Iodine in mammary abscesses. Used of full strength, he has known excellent
results in abscesses even with free suppuration, provided there is no internal
organ affected.

We read this morning in the Presse, — one of the few newspapers which are
now permitted to appear in Paris, — that one of the most learned and celebrated
professors ol the Faculty of Paris, M. Chomel, has resigned, refusing to take
the oath to the new government. The chair of internal clinic is thus left va-
cated in the school of Medicine.

It is said that the Prince President is about to abolish the system of " con-

410 T!ie New-Orleans Medical and Surgical Journal.

cours," by which the Professorships have hitherto with so much satisfaction

The old Hospitel, Hotel Dieu, we are informed, is about to be broken up or
removed. I think you will agree with me that this ought to be done, when we
find in one of the guide books of Paris, the assertion made, (I cannot sav fact,
for I hope for humanity and our profession it is not true) that of the first 500
patients received into it during the cholera of 1832, only one survived, and
only five of the first thousand. The location of this Hospital is certainly very
bad.

Heard M- Nekton lecture this morning, at the Hospital of the School of
Medicine. My expectations were fully realized. He is an excellent clinical
lecturer. In the course of the morning he used the blackboard three times to
illustrate his positions and remarks. He first exhibited the pathological spe-
cimen of an old man who had died with an artificial anus. While preparing
for an operation, he was attacked with pneumonia and immediately suffered
from bed sores about the sacrum and hips. M. Nekton remarked that M.
Malgaigne had first observed, that while patients, paralytic, for instance, may
be upon the back for months without excoriations, yet the moment an acute
inflammation attacks them, bed sores are the result. So in his case ; the pa-
tient, although aged, was doing well until the lungs became invaded. Another
remark he made was, that in all the post mortem examinations he had made of
patients who had labored under artificial anus, he had invariably found the up-
per portion of the intestine involved in the affection inside, and the lower por-
tion outside, as regards the mesial line of the body. His explanation is, that
the upper portion of the bowels becomes distended and falls naturally towards
the pelvis, while the lower portion being empty, is consequently pushed out-
wards or to the iliac fossa of one or the other side.

He next alluded to a case just received into the Hospital, seriously injured
by a fall. In relation to the question of diagnosis of infiltration of blood under
the scalp and fracture of the cranium, he said one could be easily distinguished
Irom the other, by these symptoms :

1st. In a bloody tumor simulating a fracture, let the surgeon press steadily
upon it, and the fluid being displaced, he will feel the arm resisting the
bone.

2. Should an artery, divided in the injury, give rise to the pulsation, ac-
cording to its situation, compress the temporal or occipital vessels, and it will
cease in the bloody infiltration.

3d. The pulsation of the brain differs from that of an artery ; in one case
it is an artery, in the other it is a mass moved by several vessels.

4th and lastly. If the brain be injured, and oedema of the eyelids ensue,
the infiltration will take place slowly, and first exhibit itself under the conjunc-
tiva. If the contusion be superficial, the eyelids will become puffed up at
once ; but if deep-seated, then it will appear gradual and be first subconjuncti-
val. This difference in the same condition of these organs is owing to the re
sistance of the membrane connecting the cartilages of the eyelids to the sur-
rounding soft parts.

Went to the Hospital Neckar to see the celebrated Dr. Civiale. He is quite
an indifferent lecturer, but an inimitable operator with the catheter orlithotrity
instruments. He stated in his Upon to-day, that the statistics of 11,000 cases
of lithotomy exhibited one death for every 9 infants, 2 deaths for every 9
adults, and 3 deaths for every 9 aged persons. He says he prefers cutting to
dilatation, to cure stricture of the urethra. He operated on a case by crush-
ing a fragment of a stone he had broken at a previous sitting, with the in-

May 26th.

SATURDAy, 29th.

Miscellaneous 31edical Intelligence.

411

strument now generally if not universally employed, having a beak like a
duck, with two branches, one sliding in the other. He is inclined to the opin-
ion, but not definite, that chloroform prevents reaction.

M. Nelaton's Clinic. — He presented two cases upon which he had ope-
rated. The first was an extensive necrosis of the femur, upon its anterior sur-
face, near the knee-joint. An incision through the soft parts was made and a
variety of strong cutting forceps were employed to remove a considerable num-
ber of pieces of bone. The patient was a youth, and placed under chloroform
during the operation. It was a tedious and somewhat embarrassing one.

The other one was the removal of the little finger with its metacarpal bone,
for caries at the wrist-joint. The operation consisted of an incision from the
head of the fifth metacarpal bone to its distal extremity, or metacarpophalan-
geal articulation, around which a palmar and dorsal cut was made, so as to pass
the knife between the fourth and fifth bones of the hand, when the latter was
disarticulated from the os unciforme. The cutting forceps were also used in
the wrist-joint. Chloroform was again used, but did not act as favorably in
this as in the previous case.

In alluding to the dangers of the operation, M. N. declared that it could not
be performed without opening the carpal articulation.

Mr. Costello, the editor of the Surgical Encyclopedia of London was present
at this clinic. He is frequently at this Hospital.

June 1st.

At La Charite. M. Velpeau entered to-day upon the interminable question
of cancer, preparatory to removing a diseased mamma. The French still hold
to the terms of soft and hard cancers. M, V., like all prudent surgeons, is
averse to operate upon every scirrhus, and especially upon ulcerations of a de-
cided carcinomatous character. But like others, he does operate in certain
cases. The one of to-day he thought wanting in several particulars to make
up genuine scirrhus. I was greatly surprised to see him present the patholo-
gical specimen of tiba, which he termed encepheloid cancer, taken from a lady
of Paris, who had received a fall some three or four weeks before. What would
Mr. Stanly of London say to this carcinoma of a bone ?

He removed the entire breast with a chain of glands, small, and not extend-
ing very high into the axilla, in two and a half minutes. You know he is not
an expert or very dexterous operator ; using, as he is compelled to do, the mid-
dle and not the fore-finger of the right hand, because of an injury to it in youth.
Chloroform was used in this case ; acted well.

June 2d.

At the Hotel Dieu. And what a change has come over it since I was a stu-
dent there in 1830 and '31! I went round the wards with M. Joubert de
Lamballe, one of the best surgeons and best lecturers in Paris. I saw several
interesting cases in his wards, and there is little doubt he is doing as much for
French surgery as any one else. In one case of retention of urine for stric-
ture, the bladder was punctured above the pubis, the stricture cured, a large
fistula anterior to the testicles covered by a flap slided from the scrotum, and
the patient is now nearly well. A case of stone- upon which he operated six
days previously was also doing well. The operation was the lateral, and per-
formed with a bistoury.

A fractured leg he was treating with a folded sheet, placed transversely over
it, so as to compress the limb upon the bed (hard matrass and folded cloths
over it) while extension was maintained from the perineum of the fractured
side and the ankle by handkerchiefs to the head and foot of the bedstead. A
rhinoplastic operation was not very promising.

After the visit to the wards, I went into the amphitheatre, where I had so

412 The New-Orleans Medical and Surgical Journal.

often heard Dupuytren lecture to some hundred students. I found the old vet-
eran M. Roux in his place, and counted sixteen students and 9 interns around
his table — this was his class, all told, and yet he had several operations to per-
form. M. Roux lectures, if any thing, worse than ever, being now very old ;
but still he operates with wonderful skill. At his present age, say near 80, I
saw him go through every stage of his favorite method for cataract. Having
many years ago operated upon 600 cases by the different processes proposed
to relieve cataract, he ascertained that extraction had been the most successful.
Without the aid of glasses he performed this operation as well as any one. In
extirpating the eye, chloroform was administered by an inhaler while the patient
was in a sitting position. The impression was not good, and the operation
badly performed. More than 8 minutes were consumed in its removal and the
patient suffered greatly.

June 4th.

La Charite. M. Velpeau. His lecture to-day would have pleased you
greatly. In relating the symptoms of a diseased os tins©, he came out against
the modern use (abuse) of the speculum. He declared this instrument was
never useful in displacements of the womb, or in diagnosing tumors project-
ing into the vagina. It was necessary, he admitted, in the topical application
of medicaments to the os tinea?. Few instruments had been more abused, and
it was high time honest physicians should do all they could to arrest the furor
among women for this indecent, unnecessary and injurious examination. I
could not but recollect your satisfactory argument on this subject last winter,
when scolded at a consultation of old grannies for not using the speculum —
viz : that as the patient in question did not now bear children, she therefore had
no womb, and the instrument was not required.

He removed the little finger of the right hand at the metacarpophalangeal
articulation, for deformity. The patient had had the hand crushed some years
ago, and this finger now projected upon its palmar surface. Velpeau remarked
that there were two kinds of operation per complaisance- — 1st, simply to gratify
the patient as to appearances ; the 2d, because the deformity presents or inter-
feres with his business or daily work. The surgeon, of course, is more ex-
cusable in operating under the latter circumstances than for the simple gratifi-
cation, without any useful object in view.

June 5 th.

At Hospital Neckar. M. Civiale's service. Witnessed lithotomy by the la-
teral operation — instrument, the single lithotome cache ; patient, boy of seven-
teen years ; time, three minutes and a half; stone, apparently mulberry, size
of a pullet's egg. There was rather too much parade before the operation in
preparation for it, but it was well done. Civiale did not operate, but asked his
right hand man, M. Le Noir, to perform it. Chloroform acted well in the
case.

June 7th.

Clinic of the School of Medicine. M. Nelaton. He gave to-day a most
excellent lecture on internal intestinal obstructions. The case provoking the
remarks was this. A man aged 52 was sent to the hospital by a friend of M.
N., who for five days had no faecal evacuation, great meteorism of the whole
abdomen, stercoraceous vomiting, but no fever; pulse 85. Croton oil wras given
in large doses, and the whole abdomen covered with ice. These means pro-
duced immense faecal evacuations, with immediate relief to the patient. This
morning he is very weak, pulse at 120, no appetite, and it is apprehended he
will die.

The surgeon took occasion to enlarge on the subject of intestinal obstruc-
tions arising from internal causes. These he mentioned were three. 1st.
Those arising from substances foreign to the bowels ; they may come from
without, or originate within ; instances, cherry stones, etc., and biliary calculi.

Miscellaneous Medical Intelligence,

413

etc. 2d. Intestinal ulcerations, particularly in tuberculous subjects. 3d.
Strictures, especially produced by the appendix vermiformis. Of this latter
variety two specimens were exhibited. He of course spoke of these affections
independent of hernia.

He lastly alluded to the operation for the relief of these internal strictures.
He said surgeons were averse to operate, because they could not tell where
the mechanical obstructions existed, nor could it be always relieved by opening
the abdomen. He says Dupuytren, in 1718, proposed to establish, under these
circumstances, an artificial anus, by opening the intestines above the stricture*-
M. Lauguier performed this operation in 1838 ; result unknown; but next year
M. Maisonneuve succeeded perfectly.

M. Nekton has now operated several times, with and without success, and
he now thinks that this ought to be considered an established surgical ope-
ration.

In the diagnosis of internal intestinal obstructions, the surgeon must be in-
fluenced by its sudden production.

Very respectfully, yours,

PAUL F. EVE.

XVIII.— A new mode of reducing Dislocations of the Hip Joint without pul-
leys or other mechanical means.

BY W. W. REID, M. D., ROCHESTER, N. Y.

We extract the subjoined observations, on the subject of dislocations, from
a paper by Dr. Reid, contained in the late transactions of the New York Med-
ical Society. Several cases of dislocations of the hip-joint are here reported,
in the reduction of which the method recommended below was adopted with
complete success. We can only make room for the following short extract—
the concluding portion of Dr. R.'s paper.

(Ed. N. O. Med. and Surg. Jour.)

On the 18th of December, 1849, Dr. Moore-having a subject in process of
dissection by his students, proposed to me, that we dissect up the muscles of
the hip joints, leaving them in situ; dislocate the bones and then operate on
them by traction in the usual way, and also by flexion, after my method, in
order that we might observe the condition and action of the muscles, before
and during both modes of operation.

We found it impossible to force the head of the bone through the capsular
ligament, till we had made a slight incision into it. The head then shot through
it, tearing it sufficiently to permit its passage, but the ligament seemed to fit
close around the neck of the bone- As the head passed out, backward and up-
ward, it caught the tendon of the pyriformis, tearing it ofT as it passed under-
neath and above it, which, if it had remained entire, would have brought its ten-
don like a cord across the neck, below and close to the head, lashing it closely
down to the dorsum of the ilium. We were at the time inclined to attribute
its rupture rather to the decayed state of the subject than to excessive disten-
sion by the dislocation. But precisely the same thing occurred in dislocating
the other hip, although we endeavored to avoid it by pushing the bone in a dif-
ferent direction, but as the insertion of this muscle is at the root of the tro-
chanter, it is evident it must obey its movements, and therefore preserve nearly

414 The Neiv-Orleans Medical and Surgical Journal.

the same relation to it and the head of the bone; whatever direction it takes
in being dislocated backwards, that is, whether a little more obliquely down-
ward or upward.

When dislocated, the head of the femur rested on the gluteus minimus mus-
cle ! The gluteus medius and maximus, psoas magnus, iliacus internus, ad-
ductor triceps and pectineus, were shortened and relaxed. Posteriorly, the
obturator internus, gemelliand quadratus were greatly strained, and it was ap-
parent that the pyrilbrmis, if it had not been torn off, would have been even
more stretched than they. Anteriorly, the obturator externus was stretched,
seemingly, to its utmost, powerfully adducting the bone, and thus preventing
abduction and rotation.

After carefully noting the relative position of the bone and muscles, we made
traction on the femur downward and inward over the sound limb, as we are
directed by most authors; but the moment the attempt was made the muscles
already named as being in a state of tension, became more tense, and bound the
head of the bone more firmly down on the dorsum, although all the muscles
about the joint were separated from each other, were loose, without vitality,
and almost in a state of decomposition; yet it was with great difficulty that
we could bring down the head into its socket; and when we did so, we car-
ried away a part of the capsular ligament; and if the pyriformis had not been
torn off already, it spemed impossible that it should escape rupture now. But
when we adducted, flexed and carried the limb over the pelvis, as has been de-
scribed, the reduction was effected with the greatest ease. We repeated and
varied our experiments on both joints, as often as the subject would admit, and
always with the same results. I was here enabled to correct one error which
I had committed in operating. If we carried the knee above the umbilicus
and pressed the thigh close to the body, on a line with the side, the pointing
towards the axilla, as I had always done, we brought the great tendon of the
gluteus maximus into strong tension, which would compress the trochanter so
hard, that it prevented the head from mounting over the edge of the acetabu-
lum. The reduction was effected much easier by carrying the knee as high as
the umbilicus, then abducting and rotating the thigh.

From the foregoing facts and observations, I think we may justly deduce the
following propositions :

1st. The chief impediment in the reduction of recent dislocations, is the in-
direct action of muscles that are put upon the stretch by the mal-position of the
dislocated bone, and not by the contraction of the muscles that are shortened.

2d. That muscles are capable of so little extension beyond their normal
length, without hazard of rupture, that no attempt should be made to stretch
them any farther, in order to reduce a dislocation, if that can possibly be
avoided.

3d. The general rule for reducing dislocations should be, that the limb or
bone should be removed, flexed or drawn in that direction which will relax the
distended muscles, and not by extension and counter-extension, for the simple
purpose of overcoming the supposed contraction of muscles.

4th. Dislocation of the femur on the dorsum ilii, an accident heretofore es-
teemed so serious to the patient, and so formidable to all surgeons, is reduced
with the greatest ease in a few seconds or minutes, without much pain, without
an assistant, without pulleys, without Jarvis's adjuster, or any other mechan-
ical means, simply by flexing the leg on the thigh, carrying the thigh over the
sound one upward over the pelvis, as high as the umbilicus, and then by ab-
ducting and rotating it.

Editorial — Cily Intelligence. 415

&i)e 3f£tt)~©rlecm0 Ule^tcal ani Surgkal Journal.

Vol. IX.] NEW-ORLEANS, NOVEMBER 1, 1852. [No. 3.

HEALTH, MORTALITY, &c.

We are now beginning to experience, in the better health of our city, the
excellent effects growing out of the improvements which have been carried on
in our city for the last three or four years. The good which has already re-
sulted from a better system of drainage, of paving, and a more strict attention
to the cleansing of the streets, sewers, etc., should encourage our citizens and
those in authority, to increase their exertions and extend their operations, until
all the swamp land in the immediate vicinity of the city shall be thoroughly
drained and reclaimed.

But a few years have elapsed since this city was almost annually visited by
epidemic yellow fever — a terror at once to the stranger within our gates, and a
serious check to our prosperity and commercial greatness. Five years have
elapsed since this city was visited with any thing like epidemic yellow fever;
and we confidently believe that this disease may be ultimately banished from
our midst by felling the forests of cypress and draining the lands which are
interposed between the city and the shores of Lake Pontchartrain. Whilst
alluding to the salutary influence upon public health to be derived from re-
claiming the swamp lands in our immediate proximity, we beg to call the read-
er's attention to the annual message of the Mayor of the city, sent in to the
Councils, touching this subject. With his usual sagacity and public spirit.
Mayor Crossman has, since he has been elected Chief Magistrate of our city,
urged upon the city fathers the importance and utility of extending our streets
— clearing up and draining the swamps in our rear, as measures well calcula-
ted to improve the sanitary condition of the city. In his message of the 12th
April, 1852, to the President and Members of the Board of Aldermen, he uses
the following just and emphatic language. After congratulating the citizens
■on the improvement of the public health for the past year, he proceeds : "Whilst
this gratifying result (improved health of the city) is in part attributable to the
absence of that desolating scourge which visited our city in 1849, (1847, Ed.)
I cannot resist the conclusion that much of it has been attained by the judici-
ous opening of streets in the rear of the city, thus giving freer access to the
purifying breezes from the lake. The last few years have witnessed the re-
claiming of hundreds of squares of ground from what was formerly impenetra-
ble swamp; and every foot of land thus wrested from the wilderness tends to
destroy those miasmatic influences, which in past times operated so injuriously
on the health of the city. Five years have now elapsed since the yellow fever
prevailed as an epidemic, and the time is not remote, if it be not already at
hand, when the existence of that disease will be known only in the recollection
of the older inhabitants. The prevalence of that fell destroyer has been incon-

416 The New-Orleans Medical and Surgical Journal.

testibly one of the greatest drawbacks to the prosperity of New Orleans ; and
the impression once removed that its visits need no longer be feared, we may
confidently look forward to a rapid increase in our permanent population, and
to a corresponding augmentation in our wealth, character and standing as a
community."

Such is the language of one who has resided in this city over a quarter of
a century, and witnessed the ravages of those terrible epidemics which in years
past, destroyed a large portion of our population — crippled our commerce—
checked the growth of our city and paralyzed every species of trade and ma-
nufacture. To our estimable Mayor, therefore, much praise is due, for his
unceasing efforts to drain the swamp lands in the vicinity of the city; and we
hope, since he seems fully persuaded of the deleterious influence of these hot-
beds for the generation of disease, that he will continue to direct his efforts to
the accomplishment of this important object. It is superfluous to repeat that
we fully concur in the opinion, as expressed, in the message of the Mayor to
our city authorities. The entire city should be deeply interested in this ques-
tion, and we hazard nothing in saying that when all the swamp lands lying
between the city and the lake shores shall have been cleared, ditched and
drained, yellow fever, with its cohors febrium, will be numbered among the
diseases that have passed and gone; and the student of medicine will seek only in
the record of the past, to learn its history— its symptoms and its treatment. If,
then, so much good to the interest of the city, and health to its population, has
been derived from the partial clearing of these swamps, these will be increased
four-fold when the work is fully and thoroughly accomplished. Then let our
Mayor and Aldermen carry on the work — and thus rid the city of epidemics,
and those who are to succeed us will bless our memories and hallow our
services in all time to come. Observation and experience have demonstrated
that the plague of our city — yellow fever — may be driven from New Orleans,,
— that it is a disease originating from causes accidental and not original —
causes, too, which the expenditure of a little money and time can easily re-
move, and place us at once beyond the reach of these desolating visitations.

Of the health of the city since our previous publication, the following table
will furnish a brief exposition :

DEATHS IN THE CITY OF NEW ORLEANS,

For the 9 weeks ending Oct. lQlh, 1852.

1852

Cholera.

Fevers.

Y. Fev.

Total

Aug. 2 1st,

135

" 28th,

158

Sept. 4th,

148

" 11th,

175

" 18th,

194

" 25th,

209

Oct. 2d,

154

" 9th,

175

" 16th,

180

Total,

170

409

184

1528

Editorial. — City Intelligence.

417

Of the foregoing 399 were under 10 years of age, and 166 were col-
ored.

The reader will observe that the Cholera has greatly fallen off from
the figures reported in our last number for the same time ; and as the deaths
from this zymotic form of disease declined, those from fevers rose in the same
ratio. This shows, what is generally admitted by Physicians, that two violent
diseases, whether endemic or epidemic, cannot prevail among the same popu-
lation with equal malignity at the same time ; the one must supercede or ab-
sorb the other. In this case, cholera gave way to fevers, and these latter con-
stitute the prevalent type of our diseases.

In our September number two deaths by yellow fever were reported ; but we
stated that although some doubts were entertained as regarded the genuineness
of these two cases, yet, as we had every confidence in the skill and experience
of the Physicians under whose hands the certificates of death were given, we
believed both cases were genuine. Some increase of cases since that time
goes to confirm the correctness of our opinion, and ratify the diagnosis of the
two Physiciaus in question ; for since that date (Aug. 7th) the deaths from
yellow fever (see above table) have been 184 — making nearly one fourth of
the sum total of the deaths from all the febrile diseases. Notwithstanding the
existence of a few cases of yellow fever in the city, among that class of per-
sons so liable, from bad habits and irregular living, to our endemic diseases,
still the season is much too far advanced to create any fears in the public mind
on this subject. Cool weather, with its frost and other purifying agencies, will
soon dissipate the morbid principle or principles from which the disease derives
its power and activity.

Our observations at the Hospital and inquiry among the city Physicians, have
convinced us that typhoid fever has prevailed to a very limited extent, both in
private and hospital practice, during the last five or six months. This may be
attributed to the non-arrival of many immigrant vessels during the time men-
tioned ; but as the winter approaches, we may expect hundreds and even thou-
sands to pour in upon us from the shores of Europe, worn down with disease
and starvation, and freighted with pestilence, and saturated with the poison of
typhus and typhoid fevers, small pox and other kindred diseases. In anticipa-
tion of such a dreaded importation, it becomes our city authorities to take, in
time, such steps as will secure this community against the introduction and
diffusion of these terrible plagues. A little timely precaution on the part of
those on whom it appropriately devolves, will serve to protect our citizens from
a disease, which every immigrant vessel from Europe is but too well calcu-
lated to augment.

418

The New-Orleans Medical and Surgical Journal,

YELLOW FEVER.

In our report of the city mortality for the week ending August 21st of this
year, six deaths from yellow fever were returned from the cemeteries ; and
these constitute the first cases of which we have any knowledge this season.
The week following, ending August 28th, only two deaths are reported ; but for
the third week, closing September 4th, eleven deaths are reported — (see re-
marks under Health of City), after this, the mortality, as will be seen by refer-
ence to our weekly tables, from yellow fever, steadily yet slowly increased, up
to the middle of October, at which date our observations terminate. The dis-
ease thus far has been restricted almost exclusively to the Charity Hospital?
and has prevailed among that class of persons who are new comers — strangers
to our climate and diseases, and who fly to the Hospital when disease overtakes
them. As a general rule, they are dissipated, improvident and much exposed
to those influences which are acknowledged to excite the disease; and when
such are assailed by the fever, they neglect to call in medical aid, or to apply
to the Hospital, in the early stages of the disease, when alone treatment can
be of any avail. Hence, they seldom fall under the notice of the Physician
until the third, fourth, fifth, and not unfrequently as late as the sixth day of the
disease. At this stage of the case, the Practitioner can do little more than
palliate symptoms and assist in conducting the patient through the "valley and
shadow of death." We have seen these cases eject the black vomit before
they could be undressed and placed in bed ; and numbers are admitted in the
evening and die before the Physician calls the following morning to make his
usual visits. These facts will assist in explaining the large mortality from this
fever in our Charity Hospital ; and hence we must not reckon the attacks of
the disease from the deaths that occur ; since at least three-fourths that are
admitted with the disease perish — from the causes already mentioned. The
disease has prevailed to a considerable extent this fall among the shipping,
particularly those anchored at the Levee in front of the Third District — for-
merly the Third Municipality. Many of the sailors, captains and other officers
of these vessels have been seized with the yellow fever ; but justly appreciat-
ing the value of life, they obtained, early in the attack, the requisite medical
aid, and in consequence, few died of the disease. Local causes had undoubt-
edly something to do with the fever among the shipping ; along the Levee,
for some distance, both vegetable and animal matter, running into decomposi.
tion, is thrown in great quantities, and these remain exposed to a hot sun
for days, emitting the while disagreeable and unwholesome odors — the river
beinc now too low to carry off these offensive deposits. All this evil might
be remedied, and the health of the vessels secured, by causing all this putrid
vegetable and animal matter to be deposited in barges, constructed for the
purpose, and then carried out into the stream and emptied. We are surprised
that this matter, so important to our commercial interest, has not heretofore
attracted the attention of our city authorities. Is it not the duty of the Street

Editorial. — City Intelligence.

419

Commissioner to investigate this subject, and abate the evil with as little delay
as possible ?

We shall conclude these few observations by noticing some of the peculiar
characteristics of the yellow fever, as it has presented itself this season. In
the first place, the attack seems milder — the reaction less intense and of shorter
duration — the pains, if violent at the outset, yield more readily to treat-
ment— the head-symptoms rarely resist a hot mustard foot bath or two,
and one or two full doses of quinine and opium. In the early stages the
face is less flushed — the features less altered, and the intellect less dis-
turbed, than has been usually observed in the same disease in former seasons.
Whilst the disease has appeared more mild during the stage of reaction, it
must be observed that in the latter period black vomit, hemorrhages, etc., al-
most invariably mark the closing scene of the disease. In all our experience
in this fever, (and in this others fully agree wTith us) we have never witnessed
so much black vomit and hemorrhage for the number attacked. Few, indeed,
die of the disease in the Hospital, who do not expire ejecting black vomit, or
in whose stomachs, after death, this fluid may not be found in large or small
quantities. Hemorrhages from the nose, gums, tongue, etc., are observed in
almost every case, in some stage of the disease. In the latter period of the dis-
ease, delirium is quite common, and betokens an unfavorable issue ; petechioe
are also frequent.

In some cases obstinate vomiting seizes the patient, and persists, in spite of
every effort, until fatal black vomit is thrown up, when usually all hope of sav-
ing the case is abandoned. The treatment in the early stage is limited to
cupping in some cases — hot mustard foot-baths — cold lotions to the head, and
sedative doses of quinine and full doses of opium in some instances. Of the
quinine, the dose is usually for an adult from 15 to 30 grains, combined with
from 2 to 4 grains of opium, and repeated in three to six hours. A mild pur-
gative may be premised in some cases ; the bowels may, however, be left with
safety to take care of themselves ; our aim is first to abolish the fever, reduce
the pulse, soften the skin, and thus break up the catenation of morbid influen-
ces by which the disease is propagated from one organ to another. Having
accomplished this, we may then look after the bowels, kidneys, etc., etc.

For the microscopical appearances of the black vomit this season, we invite
attention to the following note, addressed to us by Prof. Riddell, touching this
interesting point in Pathology. Dr. RiddelPs skill and address in the use of
the microscope, and the accuracy and elegance with which he describes what
he sees, are now well known and fully appreciated by the readers of the Jour-
nal. Here is his letter —

University of Louisiana, )
New Orleans, October 18th, J 852. \

A. Hester, M. D.

Dear Sir — In compliance with the request, contained in your note of this
day, to send you a brief transcript of the results of microscopic observation
upon black vomit, I present you what follows.

420

The New-Orleans Medical and Surgical Journal.

I have had opportunity to examine rather more than a dozen different sam-
ples of genuine black vomit, mostly from yellow fever patients of the Charity
Hospital ; for which samples I am indebted to the kindness of Dr. E. D. Fenner,
Dr. J. C. Cummings, Dr. Josiah Hale, Prof. Thomas Hunt, Dr. P. B. McKel-
vey, Dr. Anfoux, Dr. Nutt, Dr. Macgibbon, and others.

The dark color is due, beyond question to blood, which, in all the cases ex-
amined by me, bore the appearance of having been materially modified by acid,
Most of the blood corpuscles seemed to have been disintegrated ; broken down
into small granules, and irregular masses. [Some of them resembled figures 9,
10, Tab. I. Selected Jtems Microscopic Observation in the New Orleans Med-
and Surg. Jour. Jan. 1852.] Clots generally abounded, containing whole
corpuscles, generally spherical, and smaller than the normal size; from .00020
inch in diameter, as measured in a sample furnished September 12th, by Dr.
Cummings, to .00030 ; the usual measurement being .00025. Dr. Fenner
brought, September 12th, a post-mortem sample, from the stomach, in which
most of the corpuscles presented nearly their usual appearance, measuring
from .00025 to .00033. I have repeatedly modified healthy blood, by the addi-
tion of hydrochloric acid and nitric acid, chloride of platinum, or weak tincture
of iodine, so that the corpuscles resembled closely those usually found in black
vomit. [Vide Tab. XIV. fig. 142. op. cit.] and finding the black vomit, in se-
veral trials, uniformly acid, it appeared to me that the modification was due to
acidity.

Prof. Hunt, who gave much attention to black vomit some years since, has
favored me with a memorandum of his chemical examinations at that time. He
found the density of the clear liquor after filtration, near 1.023. The composi-
tion varied, of course, with different samples ; but one component feature was
always present, " much free muriatic acid," which Prof. H., correctly, in my
opinion, inferred, was a main concurring cause, in the production of black vo-
mit.

After the microscopic clots of disintegrated and modified blood, the next most
prominent feature in black vomit is the abundant occurrence of groups of
large, connected, beautifully developed cells ; modified epithelial cells of the
stomach, abnormally developed. These vary in diameter from .00050 inch to
.00200. In shape they are spheroid, ovoid, oblongovoid, or polyhedral ; usually
nucleated; nuclei .00012 to .00040 in diameter. These cells are filled with
granules measuring .00002 to .00004 inch. Dr. Fenner brought me for exa-
mination, pieces of stomach, which, before the death of their owners, had cast
forth black vomit. I found myriads of these cells developed upon the inner
coat, and traversed by most delicate capillary blood-vessels ; which, by a little
aid from the imagination, appeared to be newly formed.

May not this great development of delicate cells, upon the mucous coat of
the stomach, be a most important link in the chain of causation, which ends in
black vomit ? In this wise :

It may be set down as almost certain, that in the development of an embryo

Editorial. — City Intelligence,

421

tadpole, [vide Tab. XVI. and its explanation, Sept. No.] the free cells, or blood
corpuscles, move intercellularly, forming in time, by plastic deposite, the ca-
pillary and other tubes, in which they are usually seen. Now here we have a
rapid new cell formation. Blood would push forward into it, as in embryonic
development, forming capillary vessels. But the whole new structure, of cells
and capillary vessels, is of such extreme tenuity, and so devoid of the strength
which time only could communicate, as to give way, especially under the dis-
organizing influences present in the stomach ; so as to permit blood, the color-
ing ingredient of black vomit, to transude into that organ.

Dr. Fenner brought me some dark urine, and a piece of the bladder, of a pa-
tient who had died with black vomit. A closely similar cell development had.
occurred upon the mucous coat of the bladder, and the dark color of the urine
was caused by the presence of blood.

In every sample of black vomit examined, with one or two exceptions, a
small variety of concatenated Torula was observed ; and generally in great
abundance. [Vide Tab. X. fig. 102, 103, 104, exactly resembling it in size
and form.] The individual beads were oval, averaging .00018 in length by
.00012 inch in breadth.

Minute, filiform, moving Algae were uniformly present, varying from .00001
to . 00003 in thickness. [Vide Tab. XIX. fig. 1 92, 193,203.] Several jointed
forms of moving Algse were equally constant, though mostly still more mi-
nute. [Tab. X. fig. 99, 1 00, 101. Tab. XIX. fig 189. Tab. I. fig. 22.] Vital or-
ganizations still more minute, were constantly met with. [Tab. I. fig. 2, 2, 3.]
It is not probable, however, that these algoid bodies have any special agency
in producing or maintaining yellow fever.

On the 19th of October, I observed in a sample of black vomit, furnished by
Prof. Hunt, an unusually minute form, of that rather rare parasitic organism,
the Sarcina. The cells or segments were arranged mostly in squares ; and
each separate segment, having an oval form, measured near .00003 inch.
[Vide Tab. XX. fig. 206, which is more than twice as large.]

By way of comparison and confirmation, Dr. Fenner and myself examined
some black vomit, which he had kept corked up in a bottle for ten years. Dis-
integration had proceeded further than in any recent specimen observed. The
minute amorphous fragments, still retaining the dark color, were hunted over
a long time, and only two or three nearly entire corpuscles, which wore the
organic form of blood, were found. Minute crystals, furnished by no recent
sample, were seen.

Yours, truly,

J. L. RIDDELL.

422 The New-Orleans Medical and Surgical Journal

SUGGESTIONS CONCERNING THE FUNCTION IN THE LIVING
ANIMAL SYSTEM, PERFORMED BY THE VIBRATORY MOVEMENTS
OF BLOOD CORPUSCLES.

ET J. C. CUMMING-S, M- D.

One of the Visiting Physicians to the Charity Hospital.

On examining a piece of lung (under Dr. Riddell's Spencer lens of high
power) of a man who had died of Emphyzema sixteen hours previously, I was
astonished to see the blood corpuscles in motion. Expressing my surprise to
Dr. Riddell, he said the corpuscles were very tenacious of life, and referred
me to Dr. Hort's papers for observations made by himself and Dr. Hort seve-
ral years ago. Knowing that nothing was superfluous in nature, I asked the
Doctor what this vibratory motion of the blood corpuscles was subservient to.
He suggested, " to prevent the corpuscles from becoming water-logged — thus
lessening the danger of stasis and obstruction in the capillary vessels." Thus
we see in inflammation of the vessels where their coats become roughened
by disease, how happily nature has provided against a stagnation and coagu-
lation of the circulating fluid, and all the sad consequences of such a stoppage
of blood in an inflamed artery or vein. I then asked the Doctor if he did not
think that this vibratory motion assisted capillary circulation. He said he
thought it did, somewhat, as lubricating oil assists the movement of machin-
ery ; and that a solution of muriate of soda excited this vibratory motion into
increased action ; — and then suggested, that by evaporation, etc., the salt
should be concentrated near the surface, the very place where this vi-
bratory motion should be the greatest, viz : in the capillary system.

From Dr. Hort's papers I have made the following notes : New Orleans
Med. and Surg. Jour. Dr. W. P. Hort on the Blood, etc. Page 588, Vol. I.
of 1850, says: " The motion of the globules is admitted, and the description of
that motion, 4 turning over,' precludes the idea of purely mechanical agencies."
Again he speaks of " Motion being distinctly perceived by several observers."
In the same Journal of July, 1850, page 2, Dr. Riddell, in speaking of the
movements of globules in the blood by adding a solution of common salt says,
" This motion was distinctly visible twenty -four hours after adding the salt
water." Page 13 of the same number (July) Dr. Hort observes that "the
neutral salts whose effects have been tried on the blood, present great and
striking similarity of action. They are opposite to congestion in a remarkable
manner. Page 19 he speaks of muriate of soda as exalting the vitality of the
corpuscles, increasing their motion, etc., as being " decidedly opposed to co-
agulation or congestion of the blood."

If any one doubts that the blood has a distinct and independent vitality of its
own, let him place it under a good microscope and see for himself. I be-
lieve that Drs. Hort and Riddell were the first to prove the vitality of the blood
corpuscles under the microscope. And that the credit of the discovery that
a solution of common salt would excite the corpuscles into greater vibratory

Editorial. — City Intelligent.

423

action, belongs to Dr. Riddell. Now, as to the suggestion that this vibratory
motion of the blood corpuscles assists capillary circulation. It may be advan-
tageous to make a few quotations from Carpenter's Human Physiology. Speak-
ing of the circulation of the blood, page 532, after admitting that the force of
the heart is sufficient to propel the blood through the system, says, " But there
are certain residual phenomena even in man, which clearly indicate that this
is not the whole truth ; and that forces existing in the blood-vessels ha\e a
considerable influence in producing both local and general modifications of the
heart's action. Such, for instance, would appear to be the interpretation of
the fact, that whilst any variations in the action of the heart affect the whole
system alike, there are many variations in the circulation, which, being very
limited in their extent, cannot be attributed to such central disturbances, and
must therefore be dependent on causes purely local." Here Dr. Carpenter
draws an analogy between capillary circulation of animals and the ascension
of the sap of plants. I think he is clearly in error ; there can be no strict
analogy. Nowhere in vegetable life can we find any thing like a heart — high
or low — from the most gigantic oak that ever graced a forest, to the lowest
(vilest) plant that ever sprang from the earth. Besides not being able to find
any circulatory apparatus in plants, such as a heart, arteries and veins, we
find no analogy between animals and plants if we take the other horn of the
dilemma. Prof. Riddell, in the September No. of the New Orleans Medical
and Surgical Journal, 1852, page 176, says, " Endosmotic imbibition at the
rootlets and exosmotic evaporation from the leaves, contribute thus efficiently
to the ascent of sap in trees." Now, who ever heard of an animal having
either roots or leaves ? True, as Dr. Carpenter says on page 535 of his work,
"in the lowest animals the movement of the circulating fluid seems as inde-
pendent of any central organ of impulsion, as it has been shown to be in
plants." But in these very animals there is no true circulation ; they take in
oxygen by imbibition, as Dr. Riddell says, and hence can have no need of a
heart, arteries and veins.

I do not mean to say that this vibratory motion of the corpuscles is of itself
sufficient to account for the capillary circulation. I only suggest that it assists
the aforesaid circulation, and that the burden of this assistance is in a recipro-
cal ratio with the heart's action. For instance, Dr. Riddell informs me, that
he has uniformly observed that the vibratory motion in blood taken from a fe-
ver patient is much greater than that in blood taken from a subject in perfect
health.

Dr. Carpenter, page 551, remarks, t; Cases are of no very unfrequent Occur-
rence, in which the heart is absent during the whole of foetal life, and yet the
greater part of the organs are well developed." He adds, that in these cases
there is nearly always a perfect twin foetus. But Dr. Houston of Dublin, after
careful examination, has " obtained the decisive result that it seemed impossi-
ble for the heart of the twin foetus to have occasioned the movement of the
blood in the imperfect one ; and that some cause present in the latter must

424 The New -Orleans Medical and Surgical Journal,

have been sufficient for the propulsion of the blood through its vessels. Dr.
Carpenter says, same page, " It is evident that a single case of this kind, if un»
equivocally demonstrated, furnishes all the proof that can be needed of the ex-
istence, even in the highest animals, of a capillary power ; which, though usu-
ally subordinate to the hearts action, is sufficiently strong to maintain the
circulation by itself when the power of the central organ is diminished."

I could cite many other passages from Dr. Carpenter, but as they all partake
more of suggestions than demonstrations, I forbear. But I think from those
already quoted it can be seen, that great Physiologists are not satisfied that the
heart and vis a tergo and vis a fronte alone cause the circulation of the
blood.

From the foregoing I draw the following inferences :

1. That the muriate of soda, held in solution in the blood, prevents coagu-
lation and congestion of the corpuscles.

2. The vibratory motion prevents the corpuscles from becoming " water
logged" in the vessels.

3d. That the vibratory motion assists capillary circulation in a reciprocal
ratio with the heart's action. - >

NEW METHOD OF ARRESTING NASAL HEMORRHAGE.

M. Dumas has resorted to direct compression of the aloe nasi to arrest epis-
taxis. By this means he checked a most obstinate and rebellious case of nasal
hemorrhage in a subject recovering from an attack of typhoid fever. He
grasps the wings of the nose with the ends of his fingers, and in ten or twelve
minutes the most obstinate hemorrhrge may be checked.

Another method, and one which has been resorted to with complete success
by Dr. Gibon, is compression of the carotid artery, on that side from which the
blood flows. This is easily done, and is entirely free from the objections that
may be urged against the tampon, and the usual mechanical means generally
adopted in nasal hemorrhage. We glean these items from the August No. for
1852 of the Journal des Connais. Med. Chirurg.

CYANURET OF POTASSIUM IN TETANUS.
Our July issue contained some observations made by Dr. S. Martin in our
cotemporary, U Union Medicale, which would lead the reader to suppose, from
our editorial remarks, that the cyanuret failed to produce any impression on
the disease. We glanced at the article hastily, omitting to enter into details
of the treatment. Dr. Martin assures us that the medicine paved the way for

the cure which was afterwards consummated by the chloroform. He informs

us that he has treated a large number of cases of tetanus with the cyanuret of
potassium, and with the most satisfactory results in every case.

Editorial. — City Intelligence. 425

AN ANALYTICAL REPORT OF THE UNITED STATES MARINE HOSPITAL,

FOR 3 MONTHS ENDING SEPT 30, 1852. BY P. B. Mc'kELVEY, SURG.

Dischar'd in

Dis

char'din

DISEASES.

1 ^

E-
O

Arthritis -
Anaemia -
Abscess
Ankle, Sprain.
Ascites
Bronchitis
Contusion -
Colic, Bilious
" Pict. -
Caries sup.max
Constipation -
Carbuncle -
Catarrh Pulm.
Coup de Sol. -
Diarrhoea -
Dysentery-
Debility, gen.
Dyspepsia
Erysipelas -
Fever, interm.
" remit.
" yellow
" typhoid
" Conges.
Frac.Tib.& fib.
Fistula in ano.
Gonorrhoea -
Hydrocele -
Hernia - -
Icterus - -
Iritis - -
Lumbago -
Orchitis - -

1
1
1

4
5
1

1
1

1
1
1

2
9

43
7

21
1

4
1
1
1

1
1

5
2
1
2
2
1

2
1
68
12
1
10
1
1
1
2

1
1

2
1
1

2
1
7
6
6
2
2
3
2
1
2
28
4
1
2
1

151
20
1
40
2
1
1
10
1
2
2
1
1
4

Brought up -
Opthalmia - -
Paronychia
Paralysis, par. -
Ptyalism - -
Phthisis pulm. -
Pneumonia
Rheumatism
Syphilis
Scrofula -
Tumor -

Urethra, Strict, of
Ulcer -

Wound, contused
" incised
" punctured

Total -

DIED or

Brain, cong. of
Fever, typhoid

" congestive

" yellow
Phthisis Pulm. -
Spine, Injuries of
Syphilis -
Tetanus, Traum.

Total -

84
2
1

5
4
1

134

|~99
2
4
1

10
11

8
1

139

2
1

128
2
3

3
1
14
18
1

5
1

176

1
1
1
1
1
1

311
6
8
1
1
7
1
34
49
1
2
1
17
6
1
1

447

3
5
1
1
3
1
1
1

Carried up

84 99

128

311

RECAPITULATION.

Remaining in the institution July 1st, - 97
Admitted during the quarter, - 467

Total, 564
Discharged during the quarter, - - - 447
Died, 16

463 463

Total remaining October 1st, 101

J. WINCHESTER BREEDLOVE, M. D.

Resident Physician.

420 The New-Orleans Medical and Surgical Journal.

ABSTRACT OF A METEOROLOGICAL JOURNAL FOR 1852.

BY D. T. LILLIE & Co., at the City of New Orleans.
Latitude, 29 deg. 57 min. ; Longitude, 90 deg. 07 min. West of Greenwich.

WEEKLY.

COURSE

FORCE

o t

Quantity

THERMOMETER.

BAROMETER.

OF THE

WIND,

RAIN

1853.

Ratio

Max.

Min.

Range.

Max.

Min.

Range.

WIND.

1 to 10.

Inches.

Aug. 26

89 .0

74 .0

15 0

30.20

29 .80

0. 40

SW.

3.00

0.470

Sept. 2

89 .0

74 .0

15 .0

30.20

29 .92

0.28

SE.

2.60

0.145

86.0

73 .0

13.0

30 .10

30 .05

0. 05

2.55

0.065

» 16

89.0

69 .0

20 .0

30 .20

29 .97

0. 23

2.00

0.280

" 23

89.0

74.0

15 .0

30 .20

29.90

0.30

2.30

0.810

« 30

90.5

73 .0

17.5

30.20

30.13

0. 07

SE.

2.20

0.000

Oct. 7

87 .5

74 .0

13.5

30 .15

30.10

0. 05

2.30

0.020

« 14

86 .0

63 .0

23 .0

30.25

30. 10

0. 15

NE.

2 .90

0.770

" 21

83 .0

76 .0

07.0

30 .32

30 .08

0 .24

NbyE.

2.28

0.000

The Thermometer used for these observations is a self-registering one, placed in
a fair exposure. Regular hours of observation : 8 A. M., 2 P. M., and 8 P. M.

UNIVERSITY OF LOUISIANA.

The Medical Department of this State Institution will re-open about the
15th of November, 1852, complete in all its appointments. During the sum-
mer Prof. Wedderburn visited Europe, to hurry forward the preparations, mo-
dels, etc. } for the Museum, previously ordered, but which as yet remained be-
hind. The session will open under the most favorable auspices, and during the
summer and fall large additions, in the way of specimens, models, instruments,
chemicals, etc., have been made to the respective Chairs..

After the 1st of November the Professors will take charge of the Charity
Hospital, in which the student will acquire that sort of practical knowledge of
diseases and their symptoms, which can never fail him when he enters the
broad field of practice. Students and strangers will hazard nothing in visiting
the city this season, as we are free of sickness, notwithstanding reports to the
contrary.

ADVERTISEMENTS.

WORKS

®F THI SY DENHAH SOCIETY.

(LONDON.)

The undersigned having received the appointment of " Local Secretary" of
this Society for the Southern States, would respectfully invite attention to the
valuable Standard Works which it publishes each year, and furnishes to sub-
scribers, at extremely low rates. The annual subscription is only Jive dollars,
for which, usually tliree, but sometimes four, valuable volumes of the best med-
ical works, are furnished. The works of several of the last years are still to
be had.

For further information, apply to the undersigned, who will receive subscrip-
tions and have the works delivered with the utmost despatch. The attention
of Medical Colleges is particularly invited to the rare opportunity here pre-
sented, of supplying their libraries with standard works, both ancient and mo-
dern.

E. D. FENNER, M. D., Local Sec'y Sydenham Society,
Dec. 16, 1851. No. 5, Carondelet street.

UNIVERSITY OF LOUISIANA.

MEDICAL DEPARTMENT.

The Annual Course of Lectures in this Department will commence on MONDAY,
November 15th, and will terminate in the ensuing March.

JAMES JONES, M. D., Professor of Practice.
J. R. RIDDELL, M. D., Professor of Chemistry.
WARREN STONE, M. D., Professor of Surgery.
A. H. CENAS, M. D., Professor of Obstetrics.
A. J. WEDDERBURN, M. D., Professor of Anatomy.
GUSTAVUS A. NOTT,M.D., Professor of Materia Medica.
THOS. HUNT, M.D., Professor of Physiology and Pathology.
The Department of Practical Anatomy will be under the control of the Professor
of Anatomy.

The Dissecting Rooms will be open from the third Monday in October to the 1st
of April.

The Faculty are Visiting Physicians and Surgeons of the Charity Hospital, and
will attend this institution regularly, from the 1st of November to the 1st of April,
and by their Clinieal Observations and Lectures, daily delivered to the Students, will
afford extraordinary practical advantages to their medical class.

There are about one thousand cases treated daily in the wards of this Hospital.

The number of patients is nearly twenty thousand in the year.

Januaryl * THOS. HUNT, M.D, Dean.

KENTUCKY SCHOOL OF MEDICINE-

The third session of this institution will commence on the first Monday of No-
vember next, and continue four months, with the following Faculty and course of
instruction.

Benjamin W. Dudley, M. D. Emeritus Professor of Anatomy and Surgery.
Robert Peter, M. D., Professor of Chemistry and Toxicology.
Thomas D. Mitchell, M. D., Professor of Theory and Practice of Medicine.
Joshua B. Flint, M. D., Professor of Principles and Practice of Surgery.
Ethelbert L. Dudley, M. D. and James M. Bush, M. D., Professors of Special

and Surgical Anatomy and Operative and Clinical Surgery.
Llewellyn Powell, M. D., Professor of Obstetrics and Diseases of Women and

Children.

Henry M. Bullitt, M. D., Professor of Physiology and Pathology.
Erasmus D. Foree, M. D., Professor of Materia Medica and Therapeutics.
David Cummings, M. D., Demonstrator of Anatomy.

The fees for the whole course of lectures amount to 8105. Matriculation fee $5,
to be paid once only. Graduation fee $25. Dissecting ticket 10. Hospital ticket 5.

JOSHUA B. FLINT, Dean of the Faculty.

Louisville, July 6th, 1852. septl 2t

iiifllllTf ©F LOttlSVILU

MEDICAL DEPARTMENT*

FACULTY.

The lectures in this Department will commence on the first day of November next,
and terminate on the last of February.

Charles W. Short, M. D., Emeritus Professor of Materia Medica and Anatomy.
Benjamin R. Palmer, M. D , Professor of Descriptive and Surgical Anatomy.
Lunsford P. Yandell, M. D., Professor of Physiology and Pathological Anatomy.
Samuel D. Gross, M. D., Professor of the Principles and Practice of Surgery.
Henry Miller, M. D., Professor of Obstetric Medicine.
Lewis Rogers, M. D., Professor of Materia Medica and Therapeutics.
Benj. Silliman, Jr., M. D., Professor of Medical Chemistry and Toxicology.
Austin Flint, M. D., Professor of the Theory and Practice of Medicine-
T. G. Richardson, M. D., Demonstrator of Anatomy and Dissector in Pathological
Anatomy.

The fee for admission to the Lectures of each Professor is $15, payable invariably
in advance.

Matriculation and Library fee together, $15.

Graduation fee $25.

Practical Anatomy and Dissection $10.

Ticket to be taken at least once before graduation. Rooms open from the first of
October.

A preliminary course of lectures, free to all students, will be delivered during the
month of October.

Clinical instruction is given twice a week at the Louisville Marine Hospital ; ticket
$5, to be taken once before graduation.

A Clinique has also been established in connection with the University, at which
operations are performed, and cases prescribed for and lectured upon in presence of
the class.

Good boarding can be procured at from $2 50 to 3 per week.

sep l L. P. YANDELL, M. P. Dean.

MEDICAL JOURNALS,

PUBLISHED BY RICHARD AND GEORGE S, WOOD,

No. 261, Pearl street, New York.

The British and Foreign Medico-C irurgical Review, and Journal of Prac-
tical Medicine. — Published Quarterly, at $3 per annum in advance.

The Addenda to the Medico-Chirurgical Review, or Quarterly Retrospect of
American Medecine and Surgery. — Sent gratuitously to all who subscribe to the Re-
view.— Postage free, and subscription in advance.

The Annalist : a Record of Practical Medecine in the city of New York,
Published semi-monthly. — -Price, per annum in advance.

iMEo hisw^jss) jnBHrsrsffi ©©sis & mQ9

DRUGGISTS,

No. 75 CAMP STREET,

NEW ORLEANS.

Practical experience, for upwards of twenty -five years, has convinced us of the im-
portance of genuine Drugs and their preparations, when required at the bed-side.

Planters, Country Physicians and others, are assured that every article procured
from us will be of undoubted quality, and the preparations made strictly according
to the United States Dispensatory. September, 1850.

SPINQ-ABDQMINAL SUPPORTER.

This Instrument, as its name suggests, is designed as a remedy for various
complaints, dependent on a weakened and relaxed state of the Spinal and Ah-
douainal muscles. The vast number of cases of diseases; depending prima-
rily on such weaknesses, is well known to the medical profession, to which an
instrument that, would correct these evils in a satisfactory manner, and yet be
free from other disadvantages) has long been a desideratum.

SHERMAN, Agent for the South, 70 St. Charles street.

FRESH VACCINE VIRUS.

Dr. E. D. FENNER, (No. 5 Carondalet street,) will continue to supply the Pro-
fession and community with fresh and genuine Vaccine Matter. Orders by letter
promptly attended to.

New Orleans, November 1st, 1852.

SHERMAN'S NEW PATENT TRUSS.

SINGLE TRUSS,

DOUBLE TRUSS,

The attention of Physicians
who have not examined Sher
mans New Patent truss, is, by
this medium, respectfully
called to the important advan-
tages it possesses over any and
every other, being totally dif
ferent, in construction and ap-
plication, from the many kinds
hitherto offered and applied
for the relief of Ruptures. It
is curved and shaped so as to
fit close to the body, crossing
round to the fore part of the
body, the ends being attached
with a strap on the back, re-
lieving the spine, thereby,
from all pressure. The block,
or pad, mounted with a spring,
has a peculiar and agreeable
action, and is so fixed to the
mainspring with screws, that
it may be loosened and moved
to bear directly over the her-
nial ring, where, when fastened it will remain, and perfectly retain the rupture, under the most
violent exercise, or in any position the body may assume; a very important consideration, and
one, too, that is notfound in any other instrument. The truss has been successfully applied in
the largest and most difficult cases of Hernia, after every other in use had been tried, and found
wanting ; in two instances, after the parties had vainly made a trip to England and France, to find
some mechanical contrivance that would answer their purpose. Physicians are cordially invited
to call at the proprietor's office, and examine the new instrument in the success of which, it is
presumed, they feel some interest.

Physicians who recommend to me their ruptured patients may be assured of their being pro-
perly fitted with a Truss suited to the form and condition of the rupture, as my whole time is
devoted to that particular branch of surgery.

I feel proud to state to those who are far off, and have not yet seen, or perhaps heard, of my
new, useful and muchneeded Truss, that the following eminent Surgeons and Physicians have
recommended to me for treatment their ruptured patients: Drs. Stone, Cenas, McCormick,
Hester, .Jones, Moss, Eein, Cartwright, Tiffin, Valetti, 1 m-pin, and others.
My charges are reasonable, when the utility and effect of the instrument are considered.
The Truss is sold and fitted only by the proprietor, at his office, No. 70 St. Charles street,
New Orleans.

Directions for Measurement: The number of inches around the hips and side the rupture
is on.

I also use an Embrocation, a powerful astringent, in connection with the Truss, to aid in cur-
ing Hernia, and which, as a practitioner said to me, ought to be recommended in every case, as
people are generally more negligent of ruptures than of any other affliction, and therefore too
many restrictions could not be enjoined to make them careful. The preparation is applied ex-
ternally twice a-day— night and morning. I have known it and the Truss to cure ruptures in
six months, which, without the liquid could not have been cured in double the length of time.
—To guard against deceptions, I have put. it up in bottles, with these words blown in the glass :
'J. A. Sherman's Rupture Remedy, New Orleans.' J. A. SHERMAN*

SHERMAN'S PREMIUM PATENT ELASTIC
Shoulder Braces.

Shoulder Braces are an essential article of
dress— not of late origin, however, as many
suppose, for they have been used among the
nobility and higher classes throughout Eu-
rope, for the past century. They are used
for the prevention and correction of un-
sightly and injurious habits, to aid in form-
a graceful figure and manly chest ; to
enlarge the chamber in which the heart and
lungs iie-topreserve theseimportant organs
from oppression, constraint and disease, and
to allow them room for free and healthy
action. Where disease has already fixed
upon the lungs or heart, the use of the
Brace is indispensable.

Sold only at SHERMAN'S office, No. 70, St. Charles street, N. O.

THE NEW-ORLEANS

MEDICAL AID SURGICAL JOURNAL.

JANUARY, 1853 .

|p art JFiret.

ORIGINAL COMMUNICATIONS.

[.—IS TYPHOID OR EPIDEMIC PNEUMONIA IDENTICAL WITH
PERIODIC FEVERS ?

BY S. L. GRIER, M. D., OF MISS.

The prevalence in late years of Epidemic Pneumonia and its kindred
diseases in our Southern States, presents a most interesting field for
pathological investigation, and the high grade it assumes in our mortu-
ary statistics, demands that this investigation should be diligently and
earnestly pursued.

The writer would offer a few considerations on this subject, with a
view, chiefly, to elicit information from those who may have had greater
opportunities of examining the disease, and also with the hope that a
profitable discussion of the subject may be promoted thereby.

The September number of the Charleston Medical Journal contains
an essay from the pen of Dr. La Roche of Philadelphia, combatting the
opinion of those who maintain a close connection between Pneumonia
and Autumnal or Periodic Fevers. His paper, we think, satisfactorily
demonstrates that they are two distinct and independent diseases : but
the argument of Dr. La Roche, able and conclusive as it certainly is,
does not embrace and decide the question to which we wish to call at-

428 The New-Orleans Medical and Surgical Journal,

tention. No one, we suppose, unless obstinately wedded to a theory*
will contend, that the acute, sthenic, and generally sporadic Pneumonia,
as it exists in the mountainous districts of our Eastern and Middle
States, is identical with, or hears even a close relation to, periodical
fever, as it appears in malarious countries the world over. The question
of peculiar interest to us is, whether or not the Pneumonia so common
of late years in the South, known by the names of Typhoid Pneumonia,
Asthenic Pneumonia, Bilious Pleurisy, Winter Fever, Lung Fever,
and a host of similar appellations,— attacking most frequently the ne-
gro population, and often assuming an epidemic form, — is this disease,
in its causes, its development, or in its pathological character, identical
with periodic fever, and is it amenable to the same mode of treat-
ment?

In affirmation of the question thus propounded, there have been nu-
merous advocates from all parts of the country where the disease gen-
erally prevails. Foremost and most decided in support of these views
is Dr. A. P. Merrill, Professor of Materia Medica and Therapeutics in
the Medical School of Memphis, Tenn. His essay, first published in
the New Orleans Medical Journal, and subsequently in pamphlet form,
presents his views with great clearness and precision. The strong
and trenchant style with which Dr. M. supports his opinion, and oppo-
ses all, whether teachers or practitioners, who may entertain an ad-
verse theory, as well as his acknowledged ability and acquirements in
the profession, will, we apprehend, do more towards carrying convic-
tion of the truth of his positions, than any force of argument he brings
to fortify and uphold them.

The reports for successive years, made by our army officers sta-
tioned in Arkansas, and witnessing the disease as it appeared in differ-
ent seasons, and different circumstances, are also strongly in favor of
the identity of pneumonic inflammation with periodical fever. Their
opinion seems based principally on the effect of a similarity of treat-
ment. The same course wTas pursued successfully as in intermittent
and remittent fever, and therefore the origin and nature of the disease
was the same.

Various communications have also appeared in the medical journals,
emanating from sources where the disease has prevailed, and in sup-
port of these views; predicated, for the most part, upon the success at-
tending an anti- periodic plan of treatment.

Now, with all due deference to the names and the authority which
are arrayed in defence of this theory, we beg leave to differ from it.
We do not believe that periodicity is an essential element in this dis-

Dr. Grier on Pneumonia and Periodic Fevers.

429

ease, and consequently we do not believe that Peruvian bark and its
salts, as anti-periodic agents, are the essential elements in its
cure.

A few of the reasons that have influenced us in this conclusion may
not be out of place, and may serve somewhat to elucidate the question
under consideration.

1st. The season of the year in which Pneumonia prevails is one
mark that distinguishes it from periodic fever ; the latter is not more
peculiar to the summer and autumnal months, than is the former to the
winter and spring. This, say the advocates of the identity of the two
affections, is but the modification of the disease by a change of temper-
ature, in which certain local lesions are developed secondarily and su-
peradded to the primary periodical phenomena,and therefore to be consi-
dered as complications, and not the essential features and characteristics
of the disease. This explanation would have more weight, and might
possibly be admitted as conclusive, did it at the same time extend to,
and account for, other points of difference.

Pneumonia Typhoides is very frequently epidemic, and will often
appear in localities that are comparatively free from malarious diseases.
Some of the most malignant epidemics we have known have been on
plantations, where periodic fever can hardly be called at any time an
endemic disease. Such fevers, strictly speaking, are never epidemic.
Yellow fever and the epidemic forms of bilious fever, are not periodic.
The break-bone fever, we believe, knows no intermission. However
closely the fevers may be allied with the ordinary intermittent^ and re-
mittents, the point of resemblance is certainly not in periodicity. Pe-
riodic fevers, we assert, are rarely epidemic ; and the prevalence of
them bears a remarkable proportion to the degree in which we know
the locality to be affected by malarial influence. In this respect, we
think Pneumonia and periodic fever are presented in striking con-
trast.

Again — Acclimation affords no kind of security against Typhoid or
Epidemic Pneumonia. It attacks alike old and young, natives and
strangers. Whereas against periodic fever acclimation does prove, in
some degree, a safeguard. However limited this influence may be,
so far as it goes, it makes periodic fever to differ essentially from Pneu-
monia.

In the meteorological relations of these two diseases, we think we
see a marked discrepancy. However diversified and unsatisfactory
may be the theories advanced concerning the cause and origin of cli-
matic fevers, it seems to be an established fact that the combined influ-

430 The New-Orleans Medical and Surgical Journal.

ence of heat and moisture are pre-requisite to their production. The
tabular reports published on this subject demonstrate, beyond all cavil ,
that a wet summer, succeeded by a dry, hot autumn, will invariably
give rise to a corresponding amount of fever, both periodic and con-
tinued. Will any of the advocates of the doctrine in question affirm,
that heat and moisture are the precursors of Epidemic or Typhoid Pneu-
monia ? We trow not.

The susceptibility of the two races places the class of periodic and
autumnal fevers in direct variance with the class of Pneumonic dis-
eases, as aoes also the relative mortality of these two races. The ne-
gro is more liable to Pneumonic attacks than the white race, and the
complaint proves more fatal to them. In regard to autumnal and perio-
dic fevers, this statement may be reversed. The white race is the
more susceptible to these diseases and offers less resistance under them.
Is there not a contrariety here ?

One other point of disparity we may notice, that will perhaps tend
to show the antagonism, rather than the identity of these diseases. We
mean the manner in which they terminate, whether favorably or other-
wise. Periodic fever we profess to cure. We attack the disease vi et
ar?nis, and destroy the whole chain of periodical morbid phenomena by
breaking a single link in that chain. The original habit of health
again reassumes its sway, and we claim the credit of a cure. Not so,
however, in Pneumonia. By no coup de grace can we gain a victory
here. Our most successful efforts will only check the progress of the
disease, and conduct it back, step by step, through the gradual stages
of resolution, and at best we have but assisted and promoted a recovery.
There is no specific for Pneumonia. Even quinine exerts its benign
influence in this affection, as do all other remedies, by promoting reso-
lution of the disease. Their action is indirect, however obvious and
rational the process may be. The same difference of termination is
observable in the fatal event of these two classes of disease. In Pneu-
monia a mechanical obstruction and disability hinders the vital function
of respiration, and we call it death by apncea. In periodical fever the
modes of dying are various, depending on the peculiar complications
and other causes. In uncomplicated cases death would probably take
place by asthenia. Will some of the advocates of the views in ques-
tion explain and reconcile these apparent discrepancies 1

We will now look at some of the arguments adduced in favor and
support of the unity of Pneumonia and periodic fever. So far as we
are aware, they are based principally on the fact, that the two classes

Dr. Grier on Pneumonia and Periodic Fevers.

431

of diseases prevail either simultaneously or consecutively in the
same locality, and that they both yield to the same mode of treat-
ment.

Our reply to the first of these statements has been anticipated by our
previous comparison of the two diseases. Admitting the truth of the
assertion, it proves nothing conclusively in favor of the identity of those
diseases.

Upon the plea derived from the good effects of a similarity of treat-
ment, we have a word to say ; and for the present we will accept their
therapeutical views on this subject. In the treatment of diseases a
" rational empiricism" must sometimes be allowed. We will admit, for
the sake of argument, that both classes demand the same mode of
treatment, and as the writers in favor of identity say, are to be con-
trolled only by the same medicinal agents. Farther than this we can-
not follow them, and when they attempt to deduce pathological princi-
ples from such data, we must withold our assent, and oppose the fallacy
of their reasoning. It is truly the inductive process, run mad. It is
to be "imbued with the principles of the Baconian philosophy," with a
vengeance. Let us see if a few parallelisms, gathered at random, will
not illustrate its absurdity. Calomel will check the ordinary inflam-
mation of serous membranes ; it will also exert a controlling influence
over certain forms of syphilis — therefore peritonitis, pleuritis, meningi-
tis, and forsooth iritis, are identical with syphilis. Opium will arrest
a hsemorrhagic flow ; it will also alleviate pain — therefore colic and
dysentery are one and the same disease. Camphor is both anodyne
and stimulant. We give it to relieve the painful affection of chordee ;
it is also used in typhoid fever — therefore gonorrhoea must henceforth
be classed with typhoid diseases ! Upon these principles it is that
Pneumonitis and periodic fever are identified ; " the subjection of the
former to the same remedies which are found to arrest the course of
the latter, imply a close alliance, if not a common origin." Now, this
process of reasoning, we conceive, is not more false in logic than it is
erroneous in pathology. Granting that quinine is of the first importance
in the management of Pneumonia, it is by no means conclusive evi-
dence that the disease is periodical, or at all allied to periodic
fever.

In the further elucidation of the question at issue, let us examine
briefly some of the effects and properties of the drug in which the ad-
vocates of identity find so strong a testimony in its favor. The action of
quinine on the human system is at least threefold —

1st. It is an anti-periodic. This is the property which constitutes

432

The New-Orleans Medical and Surgical Journal.

its chief value, and which makes it so specific in counteracting all pa-
roxysmal affections. It possesses this power in common with a few
other drugs.

2d. Quinine is also a sedative ; or as this term implies a theory in
regard to its modus operandi, we will style it a febrifuge. This pro-
perty is not, like the first, peculiar to it alone. Many other pharmaceu-
tical preparations belong to the same class. It is this characteristic of
quinine that makes it so available in the treatment of remittent and con-
tinued fever by the " abortive method." It is our lot to practice the
profession of medicine in the community in which this practice origin-
ated, some thirty years ago. The same mode of treatment still contin-
ues in vogue ; nor do we know of a single instance in which bad ef-
fects have followed to contra-indicate its use, or challenge the wisdom
and sagacity which first suggested its employment in the management of
our endemic fevers. The rationale of this febrifuge action is some-
what obscure. Various explanations have been offered ; but we know
not that any have been received as satisfactory. Whatever its primary
action may be upon the nervous centres, our opinion is that the imme-
diate febrifuge effects are entirely owing to its sedative influence on the
circulatory system. The researches of M. Brequet, in this department
of Therapeutics, as reported by MM. Andral, Rayer and Lallemand|to
the French Academy of Science, prove that such is invariably the action
of the drug in question. The administration of it was inevitably fol-
lowed by a diminution of the force and frequency of the pulse. Of
course wrhen the heart's action is reduced, the lungs will feel a corres-
ponding relief, and no other effect upon the respiratory organs was ob-
served, except this produced through the medium of the circulation.

3d. The last effect of quinine that we shall notice, in connection
with the subject under consideration, is its tonic, corroborant, or quasi-
stimulant effect. It may seem difficult to reconcile this with the seda-
tive properties of quinine ; but that it has this stimulant effect we all
know, both from observation and personal experience ; moreover, the
scientific investigations of the savans before referred to go to show that
its effects on the nervous centres are, great cerebral excitement and a
general exaltation of the nervous functions. Its local action on the di-
gestive organs was, to produce inflammation of the mucous membrane ;
and, what is perhaps more to our purpose, the effect on the blood was
to increase the proportion of fibrine. This change in the character of
the blood does not take place chemically. When blood is drawn from
the system and submitted to the experiment, it must therefore be pro-
duced by the influence of quinine exerted upon the process ofhtemato-

Dr. Grier on Pneumonia and Periodic Fevers.

488

sis. The action is not chemical but physiological. Now what rela-
tions do these several anti-periodic, sedative and stimulant effects bear
to Typhoid Pneumonia ? As an anti-periodic it may sometimes be re-
quired in the management of the disease, when it occurs in malarious
districts. A periodic character may have been impressed upon it by
the locality ; and in such instances an anti-periodic treatment will be
necessary, in order successfully to contend with it. This by no means
proves the unity of the two diseases. It is purely adventitious and not
the essential element of the disease. A single instance occurring in a
different locality, and treated without the aid of anti-periodic agents,
is sufficient to controvert any number of cases adduced in support of
these views.

As a sedative, we think we see a much stronger reason in favor of
its use in Pneumonia. To reduce the action of the heart, and conse-
quently ensure a slower propulsion of the blood through the lungs,
would be of all things the most desirable in Pneumonia ; and this
seems to be the sole and direct influence of quinine upon the thoracic
organs.

As a tonic or stimulant, its use would seem to be indicated by the
deficiency of fibrine in the composition of the blood. This liquified
condition of the blood obtains in all Typhoid affections. The stimulant
effects of quinine upon the nervous centres is not so plainly applicable
to the disease under consideration. We have in Typhoid Pneumonia
undue cerebral excitement, while at the same time an incubus seems
weighing upon all the nervous energies. These irregular nervous phe-
nomena in all Typhoid affections, are so peculiar and so obscure, that
all attempts to solve them would perhaps have been better accomplished
by a candid confession of ignorance ; and while our knowledge of
them, as well as of the modus operandi of quinine, remains so crude
and imperfect, it would be well to make a more cautious and intelligent
use of that medicine in the treatment of them, particularly as its place
can very often be supplied by other remedies, the action of which is
more obvious to our perception.

With this reference to the action of quinine on the various functions
of the human system, we leave it for others to decide whether it be ne-
cessary to classify Typhoid Pneumonia with periodic fevers, in order
to account for the beneficial results attending its administration in that
disease. Certain we are that we have met with frequent cases of as-
thenic or Typhoid Pneumonia, in which there were no more palpable
indications for an anti-periodic than for an anti-phlogistic treatment.

434 The New-Orleans Medical and Surgical Journal.

Local depletion, counter-irritation, combined with the use of stimulating
expectorants and diaphoretics, were the means, under which the cases
referred to, progressed to a favorable termination. We do not offer
this as constituting the best and only true method by which the disease
is to be controlled ; but we wish to advance it as evidence against the
identity, or similarity, of the two diseases under consideration. Perio-
dic fever, we believe, is not generally amenable to such a course of
treatment ; and here we are reminded of the testimony which Homoeo-
pathy brings to bear on this question. This system of quackery, in
common with many others, has served to throw light on subjects of
medical philosophy, which could not have been gained without resorting
to the same unscrupulous tampering and experimenting with " human
creatures' lives," in which they have so recklessly indulged. We may
therefore be permitted to introduce their experience in the matter on
hand, and ask why it is that their most vaunted triumphs, and the sta-
tistical records to which they point with most exulting confidence, are
drawn from this very class of Pneumonic disease, while the class of
periodical fevers forces them to display the cloven foot, and invoke the
aid of a more honest and rational practice. Far be it from our inten-
tion to endorse any part of the globule or infinitesimal theory ; but we
will say, that setting aside the chicanery and fraud of the system, it is
better than an erroneous allopathic practice, inasmuch as to do nothing
is better than to do harm.

The degree of encouragement and adherence which this and the
kindred humbugs have secured, may possibly be due somewhat to the
prevalence ofroutineism in the medical profession ; and this constitutes
one of the grand objections we would urge against the reception of the
dogmas which assert the identity of Pneumonia and periodic fevers.
Admit these views and a routine practice will soon reduce the profes-
sion to a level with the veriest empirics and nostrum venders of the
day. The " quinine doctor" of this age will only succeed the "calo-
mel doctor" of the last, and neither, perhaps, will deserve a higher
grade in the scale of scientific merit than the " steam doctor," or the
" water doctor," who receives no honor at all. Ultraism in medicine
we hold is quackery, and we venture to say that among the supporters
of this doctrine which teaches that Pneumonic affections are nothing
but the local indications and concomitants of idiopathic fevers, may be
found those who a few years ago were at the other extreme, subscrib-
ing to the tenets of the Broussais school, which pronounced idiopathic
fever to be nothing but the outward expression of an internal local
lesion. If we must incline to one extreme or the other, perhaps it

Dr. Gkier on Pneumonia and Periodic Fevers.

435

would be well to reject all classification of disease, and let the practi-
tioner intelligently and judiciously adapt the treatment to each particu-
lar case, rather than thus endeavor to generalize all our climatic dis-
eases under the one designation of periodic fever, and then with oracu-
lar assurance affix the potent name of quinine as the grand infallible
remedy.

As bearing directly on this point, we quote the words of the late Dr.
Harrison of New Orleans, in whose death our profession lost one of its
brightest ornaments, and whose contributions to Pathology and the kin-
dred sciences remain the most appropriate tribute to his worth — the
best memorial of his genius. Speaking of Yellow Fever, Dr. H. says
— "As to the details of the treatment, they must be left to the judgment
of the Physician. Any specific treatment is just as absurd in Yellow
Fever as in any other disease. The Physician is not called in to treat
an abstraction, but a sick man. Remedies beneficial in one case may
be most injurious in another ; and success in practice will depend, in a
great degree, upon the sagacity and acquirements of the Physician."
These remarks are not inapplicable to our present subject. Even in
the hands of the routineist, quinine will sometimes prove inadequate to
the cure of Typhoid Pneumonia. It is one of our most fatal diseases,
and we are not sure that quinine has not sometimes helped to hasten
the fatal issue. However this may be, the wholesale and indiscrimin-
ate use of it has incurred for us the charge of empiricism. The heroic
doses of this drug in vogue among Southern practitioners, are among
the marvels of medicine. Our Northern brethren hear of them with
a smile of incredulity, if not with the sneer of derision. In this case
ridicule is certainly no test of truth, as is evinced by the wonderful dis-
coveries but recently made by our trans-Atlantic friends in the use of
large doses of quinine.* Truly they seem to us behind the age. But
will any one assert that we are entirely clear from reproach in the
empirical and lavish use of quinine ?

A few years since a friend of the writer visited the Southwest, fresh
from what Dr. Cartwright would term the " hyperborean training" of
the Northern Schools. He was not a little astonished by the free and
apparently unlimited use of quinine which he witnessed. At last it
became an object of curiosity with him to find something for which
quinine was not administered, but gave up the search as unsuccessful,
when a case finally fell under his observation — one of those terrific
accidents so common on our plantations — a lacerated wound of the hand

* See Dundas' Sketches of Brazil and Rank. Abs. No. 15, p. 208.

436 The New-Orleans Medical and Surgical Journal.

and forearm, from being caught in the saws of a gin-stand. The ordi-
nary dressing was applied to the wound, and to the amazement of our
Northern friend, the patient was placed on anti-periodic doses of qui-
nine ! !

The treatment of Pneumonia by quinine, we fancy, is sometimes
conducted on similar principles, or if not, will some of the friends of
that system favor us with the Pathology and Therapeutics on which
their practice is based 1

II.— ON THE USE OF QUININE IN TETANUS.

BY E. A. PYE, M. D., LOUISIANA.

In the spring of 1850, Dr. N. , a retired Physician of Cata-
houla parish — a gentleman of intelligence and information — called on
me to know " if I had seen any thing, in the course of my late reading,
worthy of a trial in Tetanus. " He had a negro boy, about 14 years
old, laboring under the most violent attack of Traumatic Tetanus that
he ever witnessed. The boy had fallen from a horse some weeks be-
fore, receiving a wound in the face. The wound was apparently
slight ; little attention was paid to it, and it healed in the usual time.
Symptoms of Tetanus, however, soon made their appearance, and had
gone on constantly from bad to worse, in spite of the treatment. He
had been purged, blistered, had taken opium, whiskey, spirits turpentine,
calomel, the hot and cold bath, but with no relief. " In short," said the
Doctor, " I have gone through the routine. I have tried the old prac-
tice ; unless something else can be done the boy must die." I recol-
lected that in the New Orleans Medical and Surgical Journal for 1849
I had noticed a case, reported by Dr. Brickell, of the Charity Hospital,
in which chloroform and quinine had been given, and in which the
cure was attributed to quinine, in 30 grain closes. It seemed to me, at
least, worthy of a trial — the quinine. The suggestion was at once
adopted. We decided to begin with 30 or 40 grains, and increase the
dose until some effects were produced. The Doctor was rather doubt-
ful of finding his patient alive on his return ; but promised, if he was
still living, to give the quinine a fair chance. On his return he found
all the symptoms increased in intensity. The intervals between the
paroxysms had dwindled to but a few moments of partial ease ; with
these transient exceptions, he was in a state of constant and most vio-

Dr. Pye on the use of Quinine in Tetanus.

437

lent episthotonos ; and it was evident that unless relief could be pro-
cured, death must soon close the terrible scene. Taking advantage of
the first opportunity, the Doctor got down his throat 30 grains of
quinine — examining his watch at the same time. In one hour he again
visited him ; he could perceive no change ; repeated the dose. In the
course of the next two hours the Doctor thought or fancied he perceived
slight — the slightest possible diminution in the intensity of the parox-
ysms ; at any rate the boy thought himself relieved, and begged for the
medicine. He got 30 or 40 grains. The improvement in the next
two hours was evident. The paroxysms were not only less severe, but
the interval was also decidedly longer and freer from pain. The boy's
sensation of relief was yet more decided, and he clutched at his quinine
and swallowed it with an evident " gusto." He threw his arms hea-
vily about, saying that he felt " drunk" and "happy !" The case went
on regularly improving ; the only other medicine given being an oc-
casional dose of oil, to keep the bowels open.

At the end of two weeks I met the Doctor. The boy had taken
two ounces of quinine ; was entirely free from all symptoms of Teta-
nus ; had experienced no bad effects from this enormous quantity of
quinine ; no tinnitus aurium — deafness — fulness of the head. The
muscles had become relaxed, the skin was acting finely, the bowels
were free. The only peculiar effect of the quinine being the one
mentioned above, which he frequently expressed — the feeling as if he
were about half drunk or "happy." Here a prudential regard for the
" man with the poker," or some other analogous event, from the sudden
withdrawal of an agent, whatever its modus operandi, which had kept
our patient " happy" for two weeks, despite of Tetanus, induced us to
taper off; which we accordingly did, giving him about half an ounce of
quinine, in gradually diminished doses, in the course of the following
two weeks.

I saw him at the end of this time, well, fat and hearty. The Doctor
promised to give me the notes of this case, which would have rendered
it more satisfactory. Circumstances having prevented my getting them,
I have thought it might not be altogether without interest as it is. In
this age of heroic doses of quinine, the writer records his wholesale
administration of the drug with much diffidence. He not only disclaims
the unhallowed ambition of "out-Heroding Herod," in this regard, but
deprecates truly, on the contrary, the " spirit of enormous dosing" so
rife through the land. One may, however, sometimes find himself so
situated that the maxim " occasio preeceps" must stand in the place to
him of all precedent. In the present instance, the result of treatment,

438 The New>0rlecL7i$ Medical and Surgical Journal.

the circumstances of the case, the character of the gentleman by whom
the medicine was administered — all combine to assure the writer that
the practice, though seemingly ultra, was in reality only so much so as
the occasion demanded.

Watson says there is no cure for Tetanus. Perhaps he is right ; but
Dr. Brickell records a case in which unequivocal symptoms of the dis-
ease yielded to quinine. I give you my facts for what they are worth.
Let others contribute. " Ex multis verilas"

III.— AN ESSAY ON BLOOD-LETTING, WITH ILLUSTRATIVE

CASES.

BY JOHN J. CLOW, M» D., LOUISIANA.

Notwithstanding the varied and multiplied resources which have
been added to the Materia Medica, by the discoveries of modern sci-
ence, there is no therapeutic agent which we possess that is capable of
more varied application, or of making so sudden and effectual an im-
pression, either for good or evil, upon the system, as that ancient and
much abused remedy, blood-letting ; and I may add, that like all the
other " Sampsons" of the Materia Medica, there is none which has
been more frequently misapplied and perverted from its proper applica-
tion, to the treatment of disease.

Instead of its having been an agent, the results of which could be
calculated with certainty, its application has been as empyrical as that
which has characterized the use of many others of the potent agents,
which, within the present century, have augmented the resources of the
practitioner of the present day so far beyond those of their predecessors.
But, while observation and experience in the use of these have cor-
rected many of the abuses, and yielded to a more rational application
to the various stages and conditions of disease, there appears to have
been no nearer approach to a correct application of that than in the
days of Hippocrates.

It would neither be profitable, nor consistent with my present purpose
to give a detailed history of blood-letting, from its first introduction up
to the present time ; it is sufficient to observe, that from that day to
this, with one exception, it has been used for the purpose of moderat-
ing arterial excitement, and subduing inflammatory reaction.

Dr. Clow on Blood-letting.

439

The exception to which I allude is that of Dr. Mcintosh of Edin-
burg. In the writings of almost all the older authors, it was laid down
as an established principle, that the cold stage of intermittent fever
was essentially a stage of debility ; and according to their pre-con-
ceived notions, blood-letting would increase that debility, and conse-
quently prove fatal. But from an accurate observation of the phenom-
ena of the cold stage, from perceiving that the signs of a retreat of
blood from the surface to internal parts, were evident, from ascertain-
ing, by dissection, that the viscera were overloaded with blood, and
from recollecting that in chronic cases of ague, visceral disease were of
common occurrence, and often the cause of death — from all these cir-
cumstances Dr. Mcintosh was led to conclude that the old idea of de-
bility in the cold stage was a mistaken one, and that much good might
be done by bleeding in that stage, so as to relieve the congestion of
internal organs. After entertaining this opinion for some time without
putting it into practice, he finally had an opportunity of trying it upon
himself ; and so far from any of the dreadful results occurring, it was
followed by immediate relief. Since that time the remedy has been
extensively tried, and he has given an interesting and detailed account
of it in his work on the Practice of Physic.

Without discussing the merits of the practice instituted by Doctor
Mcintosh, let us at least award him the meed of praise, for being the
first to demonstrate the real nature of the cold stage of intermittent fe-
ver, and that the visceral congestion may be relieved by blood-letting.-
But in common with all his predecessors, he used it merely as a means
of regulating and controlling vital dynamics, and consequently made
but one step in advance of them, in this, that they used it for the pur-
pose of reducing action, whereas he used it for the purpose of increas-
ing action. But according to my ideas of Pathology, this view is en-
tirely too mechanical to be applicable to the living system, which is
something more than a machine, to be kept in motion by the applica-
tion of steam, or any other merely motive power. Disease of any sort
is something more than deranged or perverted action ; and Pathology
something more than a collection of hypothetical opinions, hung on sol-
itary facts, ingeniously devised to explain this or that symptom. "Nor
is Therapeutics a system ingeniously arranged to explain the modus
operandi of this or that remedy. Nor are they a partial set of opinions
erected on owe only of the many pedestals of fact on which the science
of medicine should stand." (Mcintosh.)

It is so seldom that we see blood-letting even alluded to, in essays on
the treatment of Southern diseases, that we might be led to suppose

440 The New-Orleans Medical and Surgical Journal.

that it had been banished from the list of remedial agents ; or is it that
quinine in large doses has so completely engrossed the attention of the
profession, as to cause them to treat it with silent contempt ? Some
eighteen or twenty years ago it was a favorite remedy in continued fe-
vers of almost any type : and among the objects for which it was em-
ployed, was that of cutting the fever short. And for this purpose it
was frequently pushed to an alarming extent. It was thought that a
small quantity, whatever its immediate effect, was of no service in cut-
ting short the fever, and consequently, if the pulse returned to its state
of reaction, the remedy was repeated ; and thus the vital powers were
soon made to succumb to the heroic treatment, and either the disease
or the constitution of the patient was compelled to capitulate at dis-
cretion.

But in the fevers which have prevailed for some years past, the bad
effects of copious abstractions of blood, even when used in the outset
of the disease, for the purpose of cutting fever short, have been so ap-
parent, that even those who were trained to its use in previous years,
have long ago ceased to expect that by such a measure fever may be
broken abruptly in its progress.

But because experience has led us to the abandonment of the mea-
sure as a means of cutting short the most common varieties of idiopa-
thic fevers, or of moderating arterial excitement, even in those va-
rieties of acknowledged inflammatory character, is it not high time
that we should examine into the principles which have guided us in
its application, before we reject its aid altogether in the treatment of
diseases. If, upon an examination into those principles, they should
prove to be unsound, would it not be better to discard them, and adopt
those which reason and experience prove to be more consistent with
an enlightened Pathology ?

What are the rules which should guide us, according to the present
doctrine, in the use of this remedy in the treatment of fevers ? —
They are —

First. It is most serviceable in moderating reaction which tends to
the inflammatory character, and in cases which put on the character of
synocha and synochus.

Second. It should be employed only where general reaction runs
high, as ascertained by the state of the pulse, the animal temperature,
and local signs of inflammation.

Third. It should be regulated as to extent, partly, of course, by the
age and constitution of the patient, and partly by the type in the parti-

Dr. Clow on Blood-letting.

441

cular case ; but more especially by the prevailing character of the
epidemic — larger evacuations being borne in the inflammatory than in
the typhoid epidemics.

Fourth. Of the special criteria for regulating its extent, the safest
and most precise is the state of the pulse, both before the vein is
opened, and likewise under the flow of blood- It is most useful where
the pulse is incompressible, whether it be feeble or contracted, whe-
ther very frequent or moderately so ; and when it improves in softness
when hard and full, and in fullness when contracted — but not under a
very slight loss of blood. It is least useful, and often inadmissible,
when the pulse is easily compressible, whether soft or jarring, and
whatever its frequency ; and when under the flow of blood it becomes
either more jarring, or easily and quickly feeble, and fluttering, or
slow.

Fifth. The effect on the one hand upon the symptoms of reaction,
and on the other upon the adynamia, or nervous exhaustion, will gene-
rally decide whether the remedy has been correctly appealed to, and
whether it ought to be repeated.

On the whole, much practice and discrimination are necessary to
use the remedy with any advantage, or even with safety, for moderat-
ing reaction in the first week of continued fever ; and it is so rare to
find a case in which the conditions above enumerated obtain, that it
has been abandoned by many of the most experienced and discriminat-
ing practitioners ; and in some instances, for no other reason than
that those who practice it are the most unsuccessful in the treatment of
fevers.

My own experience in its use, the first year of my practice in the
South, (1834) soon convinced me that as a general remedy in fevers it
could not be relied on, and from that time up to the fall of 1842, I ne-
ver resorted lo its use except in well marked inflammatory affections,
such as acute rheumatism, pleurisy, pneumonia, etc.; and I have known
some practitioners who reprobated its use even in these. But at the
time alluded to, I met with several cases of malignant intermittent, re-
mittent and continued fever, in which all the ordinary modes of treat-
ment were so totally inefficient, that I began to consider whether blood-
letting might not be so practised, as not only to be admissible in fevers
of an adynamic character, but really one of the most prompt and effi-
cient remedies which we possess.

Having seen some cases in which persons expired in the second
paroxysm of intermittent congestive fever, without any exhausting

442 The New-Orleans Medical and Surgical Journal.

discharge, and with their usual quantity of blood, their weakness and
death could not have proceeded from the want of blood, or from any or-
ganic lesion, but from the want of red blood. According to Goodwyn,
the only cause of the cessation of the contractions of the heart, when
the chemical phenomena in the lungs are interrupted, is the want of
excitement of the ventricles with red blood. And according to Bichat,
under such circumstances there is a general affection of all the parts;
the black blood, driven every where, carries weakness and death to
every organ that it enters ; that it is not from their not receiving blood,
but from their not receiving red blood, that each organ ceases to act ;
that, in a word, all are then penetrated by the malarial cause of their
death, namely, black blood, (Phys. Researches.) No one who has
seen a person in the stage of collapse of congestive fever, can doubt
that the blood is in a non-oxygenated condition, and that they die from
asphyxia.

If blood-letting could be practised, not only with safety, but with ad-
vantage, in the cold stage of intermittent fever, when performed in the
ordinary way, would it not be much more so if performed on a number
of veins at the same time, and thus abstract a larger quantity of purely
venous blood, while we take away little or no arterial blood ? For it
must be evident to any one who understands the anatomy and physiol-
ogy of the sanguiferous system, that in taking a pint or a quart of blood
from one orifice, there will as much or more arterial blood escape as
there does of venous blood, and the strength of the patient will be re-
duced in a corresponding ratio. But if we open an orifice in both
arms and both legs at the same time, we may take eight or ten ounces
from each, and thus obtain from thirty-two to forty ounces of purely ve-
nous blood.

This opinion was strengthened by reflecting on a mode of blood-let-
ting practised, it was said, with a happy effect, in the latter part of the
last century, called Riverian, from the name of the practitioner who
first introduced it ; that was, to take it in small quantities often re-
peated ; it struck me at once that its only advantage consisted in taking
no arterial blood.

These reflections, together with the consideration that the essential
cause of the congestion and engorgement of the capillary system is
owing primarily to a vitiated state of the circulating fluids — all forced
the conviction upon me, that the venous blood might be taken in a con-
siderable quantity, even in the state of collapse in congestive fever,
for the purpose of relieving the oppressed internal vital organs, and
with the effect of restoring the lost equilibrium of the circulation, and

Dr. Clow on Blood-letting.

443

thus producing reaction, and at the same time restoring the function of
calorification*

I was so far convinced of the truth of these deductions, that I deter-
mined to test them on the first opportunity, which occurred on the 19th
November, 1842. 1 was sent for to see Mr. D. Jackson, aged about
35. He had been in bad health for a month or more, but was able to
be about. (The weather had been wet and hot, until about the first of
this month, when it had become quite cool, and on the 18th a violent
north-wester blew all day and at night there was a severe frost — freezing
water standing in vessels an inch thick.) On the morning of the 19th
he was seized with a violent pain in the right side, extending from the
right lumbar around to the epigastric region. He complained of con-
stant coldness, and that his right leg was colder than the left. His
tongue was covered with a thick white coat, his pulse contracted, weak,
and compressible, his breathing oppressed and laborious ; in short, his
whole appearance presented the tout ensemble of the deepest anxiety
and distress, and under ordinary circumstances, such a case as I would
dislike to see, but at this time I must confess I was glad to en-
counter.

Treatment. — I immediately ordered a tub of warm water, and had
his feet put into it. I then corded his legs and opened a vein in each.
I then corded and opened a vein in each arm, from which the blood
ran pretty freely. I watched the effect upon the pulse, and soon found
that it increased in volume and strength. I let it run until I had taken
about a quart from both arms, without any perceptible change in the
color of the blood, it being very dark and thick, and coagulated with
out a separation of serum, like clabber when first formed. The blood
from the legs, the veins being small, did not run very freely, and from
the appearance the water in the tub presented, I supposed that there
was not more than eight or ten ounces came from both legs. After
putting him to bed, I applied four cups to the right hypochondriac region
and took about an ounce of blood with each. I then gave him ten
grains carb. am. in solution, and ordered hot sage tea to be given to
him freely, which soon produced copious perspiration. I then gave a
pill, composed of calomel 5 grs., blue mass 5 grs., morph. half gr., and
left three similar ones to be repeated every four hours until he took
them all, and the next morning a dose of oil and turpentine. I then
left him, and so confident was I of the success of the treatment, that I
did not return to see him.

I saw him about a week afterwards in town, and he told me that the

444

The New-Orleans Medical and Surgical Journal.

medicine had acted well, producing free bilious evacuations ; and that
he had taken a dose of blue mass afterwards, which was all that he had
taken, and he was then quite well.

This case occurred at a time when the character of prevailing dis-
eases was unusually severe, several cases having terminated fatally in
a few days, and where they lingered long, they invariably assumed the
typhoid character; and I had one or two cases of this latter descrip-
tion, which had commenced with pretty much the same symptoms thai
this case did, especially coldness of the right leg, which persisted to-
the last ; and I am confident that under ordinary treatment his case
would have been a tedious and difficult one ; but the treatment adopted
cut it short in its forming stage, before fever was fully developed.

I am satisfied that the principles which should guide us in the treat-
ment of fevers in this climate, ought rather to be, to anticipate reac-
tion, and prevent it, than to suddenly cut it short, after it has taken
place. And the neglect of this principle, in the use of blood-letting,
is why the remedy has so often proved injurious rather than beneficial.
It is generally resorted to in the height of the paroxysm, when the na-
tural tendency is to terminate in a profuse sweat, which, of itself, is in
many cases sufficiently exhausting, and the consequence is, that in
many instances, a state, if not of complete collapse, at least bordering
on it, is induced ; and the case is converted from one of high reaction
into one of congestion. This is favored by more than one circum-
stance.

First. There is generally more arterial than venous blood taken by
the operation, and the strength of the patient is reduced as much or
more than the disease.

Second. The operation is generally performed while the patient is
in an erect position, so as to produce syncope ; for it is not considered
efficacious unless this state is induced ; than which nothing can be
more absurd and irrational. Admitting the principle to be a correct
one, in highly inflammatory cases, where all the vital powers are in a
state of preternatural exaltation,, — to bleed to syncope for the purpose
of reducing this state of excitement, down to that state which is most
favorable to a termination of the inflammation by resolution, and for the
purpose of relieving the capillary system of a portion of its blood. If
practised early enough, I admit that it will fulfil this indication. But
if deferred until it is too late to answer this purpose, it is a bad practice
even in the treatment of inflammation, as it will most certainly cause
copious effusion, either of serum, of lymph, of mucus, or even a depo-

Dr. Clow on Blood letting.

445

sit of fibrinous concretions; depending on the seat of the inflammation'
and either of these terminations may prove suddenly fatal, or bring on
secondary affections that will ultimately end in death.

But the condition of temporary reaction which constitutes the hot
stage of idiopathic fevers, is a very different state from that induced by
inflammation. It is an excited or preternatural state of the nervous
and cerebral functions, inducing a temporary exaltation of the sanguif-
erous system, and must, according to the laws which regulate nervous
action, exhaust itself. Besides, this stage of excitement is the only re-
cuperative process which takes place in all the phenomena of fevers ;
and blood taken at that time is more highly vitalized than at any other
period in the whole course of the disease. The circulation being ac-
celerated, and the metamorphosis of the tissues, and the secretions and
excretions being for the time suspended, the whole powers of the sys-
tem appear to be concentrated on the functions of the lungs, and hence
the chemical phenomena are very striking. This is evinced by the
excessive heat, both at the capillaries of the surface and in the lungs—
for both are concerned in the oxidation of the blood, and in the process
of calorification. (And hence blood taken at this time is highly arteri-
alized.) And by the time the nervous excitement has exhausted itself,
the secretions are restored ; the pulse loses its hardness and fulness ;
the breathing becomes free and natural ; the bowels are more easily
acted upon ; the heat of the skin subsides ; the headache and thirst
abate ; the appetite returns ; and there is a gradual subsidence of the
febrile symptoms ; and in some cases a perfect remission or state of
apyrexia takes place. This taking place, the patient is frequently en-
abled to return to his usual avocations as if in full health. And those
cases in which the stage of excitement is the highest, are the very cases
in which the apyrexia is most complete.

Why, then, in a forced and unnatural manner, cut short that which
is so salutary in its effects ? Would it not be more rational to moder-
ate the excitement when excessive, and prevent or subdue local deter-
minations — for this is really the only danger in this condition? This
may be done by diaphoretics and cold applications ; by a judicious ap-
plication of cold water or pounded ice during this stage, we may
guard against the bad effects of undue local determinations ; and by the
administration of proper diaphoretics we may reduce the excitement,
and terminate the paroxysm by diaphoresis. But the diaphoretics
which are proper to this condition, are not the depressing agents too
often resorted to, such as tartar emetic, ipecac, etc., which, like blood-
letting, are applicable to the inflammatory condition, for the purpose of

446 The New-Orleans Medical and Surgical Journal.

reducing arterial excitement. But in the condition we are now con-
sidering, we should select those diaphoretics which combine stimulat-
ing and sedative properties. For this purpose spirits nitre, paregoric,
tr. digitalis and ant, wine, in the proportion of four parts of the first,
two parts of the second, and one of each of the last, forms a valuable
compound ; and in teaspoonful doses every two hours, may be admin-
istered with the happiest effect. But no remedy, in my hands, has
proved so generally applicable to the hot stage of fever, as carb. am-
monia, administered well diluted with cold water, together with a plen-
tiful supply of any of the domestic teas, such as sage, balm, catnip,
etc., etc.

To return, however, from this digression, to the point under consid-
eration. That is, the proper time to take blood, and the indications to
be fulfilled in its abstraction in idiopathic fevers. This question in-
volves another, which, however, would be out of place to discuss here
— that is, what agency a deteriorated condition of the blood has in the
causation of fevers. I shall dismiss it for the present, on the presump-
tion that this much at least will be conceded, viz., that a deteriorated
condition of the blood does exist, even in the incipient stage of all fe-
vers, and that in congestive fevers the venous, or black blood, is in an
undue proportion to the arterial or red blood. This is evinced by the
contracted state of the arterial system, and the dilated or distended
state of the venous system, — the pulse being small or contracted, and
quick and weak, — while the veins are distended and large ; the skin is
cold, the respiration is oppressed and laborious ; all proving that a
stagnation of the blood has taken place within ; and that it is not in
the arterial system is evident, for the arteries have the power of dilat-
ing and contracting their dimensions according to their contents, and
we find them contracted to their smallest dimensions.

According to the calculations of physiologists, there is about two-
fifths of the blood circulating in the arteries, and three-fifths in the
veins, when in a normal condition, Judging then from the difference
between the volume of the pulse in a state of health and that in a state
of congestion, there cannot be more than one-fifth of the blood in the
arterial system in that condition. It is evident then, that in taking
blood from a single vein in any considerable quantity, we reduce the
strength of the patient more by the quantity of arterial blood that is
taken through the vein, than the amount of venous blood relieves the
congestion of the venous system. But if we open four veins at the
same time, and take from eight to ten ounces of blood from each, we
take a sufficient quantity to relieve the oppression of internal organs.

Dr. Clow on Blood-letting.

447

without at the same time taking away that portion of the vital fluid
which is essential to nutrition. For the blood in the veins has already
been deprived of those elements which enter into combination with
the tissues, and has received those effete and worn out matters which
have been thrown out in the metamorphosis which takes place in the
capillary system.

It is supposed that the weight of the blood is equal to one-fifth of the
body. An ordinary sized man then has from twenty. five to thirty
pounds of blood, and in health, from ten to twelve pounds of this is ar-
terial blood, and from twenty to twenty-four pounds is venous. But
in the congestive condition, the proportion of arterial blood is dimin-
ished to one half ; and we have but five or six pounds of red blood,
which, being insufficient to support the vital functions, death rapidly
ensues. But by taking away a portion of the black blood, and at the
same time stimulating the respiratory organs to increased action, the
equilibrium is soon restored, and a regular and healthy reaction is the
consequence. If, on the other hand, we by excessive stimulation
should succeed in bringing about a partial and imperfect reaction, and
then open a vein, and the pulse should even begin to improve, it will
soon sink again, and you are compelled to stop it before there is enough
taken to produce any good effect ; and if the immediate effect should
be apparently good, the delusion is soon dispelled by the subsequent
weakness. The reason of this is, that in taking even sixteen or twenty
ounces of blood from one orifice, we take as much arterial blood as we
do of venous blood, and the consequence is that the strength is reduced
as much as the congestion is relieved, and there is nothing gained by
the operation. The rules which govern me in taking blood in idiopa-
thic fevers are —

1st. Never to bleed during the paroxysm for the purpose of redu-
cing arterial excitement, or of cutting the fever short.

2d. If I bleed at all during the stage of excitement, it is in cases
of suppressed excitement, or imperfect reaction ; and it is for the pur-
pose of developing the excitement ; and consequently I administer sti-
mulants at the same time.

3d. If I am at liberty to choose the time of bleeding, I prefer that
period which immediately precedes the first paroxysm, and this having
elapsed, the next is that which is intermediate between the first and
second.

4th. In all febrile affections, bleed in the recumbent position, and
from small rather than large orifices, so that the circulation shall be
disturbed as little as possible.

448 The New-Orleans Medical and Surgical Journal.

5th. Cord all the limbs intended to be operated on, before opening
an orifice in either, so as to give the black blood time to accumulate
in the veins*

If these rules are complied with, four or five pounds of purely ve-
nous blood, in many instances, may be taken, and so far from weaken-
ing the patient, he is, on the contrary, immediately strengthened ;
for I have in more than one instance tried it on patients who were so
weak, that they could not sit up without feeling sick and faint ; but
who were, after the operation, able to get up and walk to bed; for I
generally, before bleeding, place the patient on a pallet on the floor, so
as to have convenient access to all the limbs. In all cases where de-
bility comes on suddenly, without being preceded by any exhausting
evacuation, the debility is more apparent than real, and in those cases
the pulse will be small, weak and compressible ; but so far from this
circumstance deterring me from using the lancet, I consider its neces-
sity more urgent. For in those cases, if the blood runs at all, the
pulse will become fuller and stronger ; and if it does not run, it
can do no harm to open the veins.

Another argument in favor of this mode of taking blood is, its caus-
ing derivation from parts actually inflamed, or congested, to other parts
of the body. Whether this effect is, as Haller taught, inexplicable on
merely mechanical principles ; or whether, as Magendie asserts, it is
merely the effect of the contractile power of the vessels, and the forced
state of distension in which they exist during life, causing a flow to
any point where an opening is made, it is quite certain that a move-
ment in that direction is immediately perceived in all the small ves-
sels which can be brought within the field of the microscope, on a
puncture being made on any one of them ; and in Haller's observa-
tions, it distinctly appeared that these movements often inverted the
natural course of the circulation, and often extended to portions of
blood which were stagnating in vessels, and caused globules to sepa-
rate and become distinct, which had previously aggregated into irregu-
lar masses. This being so, it cannot be doubted that similar changes
must be effected, in a greater or less degree, in the blood stagnating
in inflamed or congested parts, when an exit is given to the blood from
other parts of the circulating system, whether by local or general
blood-letting. And it is on this principle that we can account for its
influence in arresting internal hemorrhages, as well as by reducing
the quantity of the circulating fluid, and thus relieving the local turges-
cence on which the hemorrhage primarily depends.

Dr. Clow on Blood-letting.

449

It is well known that these hemorrhages reduce the strength much
more than the loss of double that quantity of blood would do, if taken
from a vein. The reason of this is, that the blood flows directly from
the arterial system, and hence the necessity of taking blood from the
venous system, and thus restore the equilibrium between the two
so as to enable the weakened organs to perform their functions,
all of which depend upon the blood. For instance, the arterial blood
penetrates every organ, supplying them with nourishment and strength
to perform their functions, and the venous blood penetrates their cells,
(at least two of the largest and most important ones, the liver and lungs)
to be acted upon and converted, partly into red blood, and partly into
secretions, to subserve certain purposes, and to be finally excreted from
the body as effete matter. Is it not more consistent then with reason
and common sense, to relieve the weakened organs of a part of their
labor, by taking away a portion of venous blood, than by stimulating
the organs to increased exertion to perform the same, or even a greater
amount of labor, than they are in the habit of performing in health?

For the purpose of illustrating certain points in the foregoing re-
marks, I will introduce a few out of many cases which I could bring
forward ; and the first which I shall introduce will be to show that a
larger quantity of blood can be taken in the way proposed, without
producing syncope, than from one orifice. For this purpose I bled the
same individual both ways at different times.

Mr. B. K. S., aged about 30 years, of sanguine temperament, and
naturally strong constitution, but had just recovered from a spell of bil-
ious fever, (in which he had been treated the ordinary way by another
Physician ; he had been up, however, for several days, and had been
riding about attending to business, and came home on the 20th Septem-
ber, 1S44, with a fever. I was immediately sent for, and on my
arrival found him with a full, bounding pulse ; a hot and dry skin ; se-
vere pain in the head ; tongue slightly furred with a white coat, and
some gastric irritation — presenting conditions necessary to admit of
blood-letting, according to the commonly received doctrine. I therefore
corded one arm and bled him from a large orifice, in a sitting position ;
not more than sixteen or eighteen ounces of blood had been taken when
he complained of feeling sick and faint, and before I could get the
bandage adjusted, he fainted and fell on the floor. After recovering he
was put to bed, but remained quite weak and exhausted all night. I
gave him a couple of blue pills that night, and the next day put him
on quinine, and he had no more fever, and in a few days was able to
attend to business.

450 The New-Orleans Medical and Surgical Journal.

On the 13th of October following, having been from home several
days, he returned with a chill. He sent for me, and stated on my
arrival that he had ridden sixteen miles with a chill, and was then
lying with his feet to the fire, and complained of being chilly. There
was, however, some reaction, and I proposed bleeding him, to which he
assented. He again sat in a chair, and I corded both arms at the
same time, and opened a vein in each, from which the blood flowed
freely until I had taken a quart. I then bound them up, and he went
to bed without any assistance, and said that he did not feel the least
faint. I gave a couple of blue pills, to be taken at bedtime, and left him.
The next morning I called over to see him, and he had ridden off a dis-
tance of eight miles ; his wife said that he expressed himself as feeling
quite well, except a little weakness. I expected he would come home
sick again, but I was mistaken ; he had no other relapse that
season.

In pneumonia, bronchitis, and pleurisy, the superiority of this mode
of abstracting blood is, perhaps, more peculiarly manifested than in any
other class of diseases. For, in addition to its influence as a means of
direct depletion, by taking away that portion of the blood which requires
the functional agency of the affected organs, in order to fit it for nutri-
tion, it thus, by diminishing the necessity for increased exertion, enables
them to perform their functions on the remaining quantity of blood, so
as to fit it for supplying the other vital organs with nourishment and
strength to discharge their functions.

And in some cases of acute inflammation, affecting the substance of
the lungs, even after hepatization has taken place, we may prevent death
from ensuing by a judicious abstraction of blood, so as to enable the
remaining portion of sound lungs to accommodate itself to the require-
ments of the system, or rather to enable the sanguiferous system to ac-
commodate itself to the new state of things which has taken place in
the lungs. That such a thing is possible, may be illustrated by many
cases of slower progress, (chronic pneumonia, chronic pleurisy, and
phthisis) in which a whole lung, or even the greater part of both lungs,
may be rendered impervious to air without urgent dyspnoea, or death by
asphyxia. In these cases we know that the whole quantity of blood
in the body requiring to be arterializcd, is very much diminished, and
at the same time the distribution of blood in the lungs is gradually
accommodated to the new state of things ; the vessels of the diseased
part are gradually deserted by the blood and become atrophied, and
finally close up and become mere tendinous bands ; while those of the
sound part are filled and dilated to their utmost capacity ; as is clearly

Dr. Clow on Blood-letting.

451

shown by injections after death ; and it is partly because these changes
cannot be rapidly effected, and partly also because a partial pneumonia
is often attended by a more general bronchitis, that the respiration is
so much, and often so fatally embarrassed, by the inflammatory condi-
tion even of one lung.

I fear that I would be too far trespassing upon the proper limits
of an essay, as well as the patience of the reader, to introduce cases
to illustrate the treatment in the first stage of pneumonia or phthisis ;
I shall therefore simply give an outline of the general treatment when
called to a case in the first stage.

By a single general bleeding, in the way recommended, say eight or
ten ounces from each extremity, and four or five cups over the affected
lung, generally the right one, followed by warm mustard or cayenne
poultices over the whole chest, and carbonate of ammonia and hot teas
administered to produce diaphoresis, and squills and blue mass to pro-
duce expectoration and restore the secretions, and at night opium or
morphia to allay nervous irritability and cause sleep, the next morning
a dose of castor oil and turpentine to operate on the bowels, and quinine
through the day; and in nine cases out often, if the case is simple and
uncomplicated, and you are called early enough, the case will require
no other treatment than probably an additional dose or two of medicine,
to keep the bowels open until the vitiated excretions are carried off, and
a few doses of quinine.

This is the simplest form that we meet with of these affections in
this country ; but they are sometimes complicated with abdominal, vi-
ceral derangement, most commonly of the liver and spleen, but some-
times of the stomach and bowels ; the latter by far the most danger-
ous ; these special local indications must be treated with the appropriate
remedies, precisely as if we had the two diseases to contend with se-
parately, with this difference ; that the treatment must be more prompt
and energetic in the first stage, before the constitution sinks under the
combined attack. But in most cases if the treatment is prompt in the
early stage, these complications seldom develop themselves ; for, so far
as my observation and experience extend, they are generally secondary,
and in some instances brought on by improper treatment ; more espe-
cially the affection of the bowels, which is in nine cases out of ten
brought on either by drastic purgatives or tartar emetic.

I will introduce one case of pneumonia, in which I bled the patient
on the twelfth day, when there was no doubt on my mind that hepatiza-
tion had taken place.

452

The New-Orleans Medical and Surgical Journal.

January 18th, 1846. Received a note from a neighboring Physician,
requesting me to visit Mr. J. B. N., who had been sick eleven or twelve
days, and as the Physician was compelled to leave him to go to the
city, he wished me to take charge of the case. When I arrived, a little
after dark, I found that the Doctor had left that morning ; I was conse-
quently left to my own judgment to ascertain the nature of the case and
the treatment which had been pursued. Upon enquiry, I found that
he had not been bled ; that he had been purged excessively ; that he
had been taking antimony in nauseating doses ; that he had occasion-
ally had an opiate, and that he had been blistered. He was a man of
about 35 years of age, of sanguine temperament, and strong consti-
tution. His pulse was quick and tense ; his tongue dry and co-
vered with a brown coat ; his skin was dry and harsh. His breathing
was difficult and oppressed ; dullness on percussion over the lower half
of the right lung, crepitant rale, on auscultation, a depression over the
right clavicle, and a dry cough. The discharges from his bowels were
dark and watery, his urine high colored and scanty.

Treatment — I corded both arms, and opened the veins (and as it
was inconvenient to take blood from his legs, I concluded to depend on
what I could get from the arms), and let the blood run slowly, (which
is very important where there is structural disease of the respiratory
organ), and watched its effects. I soon found that the pulse was im-
proving, becoming softer and fuller, the respiration became easier, and
presently a slight perspiration was perceptible. I let it run until I had
taken about twelve ounces from each arm. I then bound them up,
and gave him carbonate of ammonia, and he was soon in a profuse
perspiration. I next put a large blister over the right side of the chest,
and gave him a pill, composed of blue mass, calomel and morphia,
every four hours, until he had taken four, which were followed by a
dose of oil and turpentine the next day. In the meantime he took the
following mixture through the night as an expectorant and diapho
retic :

R Carb. Ammonia 3 ss

Aqua Fonta §ij

Syrup Scillse 1 i

First dissolve the ammonia in water, and then add the syrup, and stir it
until effervescence ceases. Of this mixture give a table spoonful every
two or three hours.

He slept well, which was the first time for several nights. He was

Dr. Clow on Blood-letting.

453

expectorating freely, and expressed himself as feeling much better. I
dressed the blister, which had drawn well, and gave him the oil and
turpentine, and remained with him until it had operated upon the
bowels.

I left him at 1 1 o'clock so much improved, that I told his wife I would
not return, and left medicine for him to take that night, with instruc-
tions to send up the next day, and let me know how he was doing.

January 20th. — Received a note from Mr. N.'s brother, stating that
he was still improving, and the medicine had acted well. I sent medi-
cine, and heard afterwards that he was getting well. But on the 10th
of March I was sent for to see him again. His cough had never left
him, and the expectoration had increased to such an extent that he
thought he had consumption. When I arrived I found him sitting up,
although quite weak and emaciated, and discharging large quantities of
thick purulent matter ; it was first, he said, mixed with blood, but it
had gradually changed and assumed its present appearance. He had,
on percussion over the right lobe of the lungs, a hollow, cavernous
sound, pectoriloquy or loud resonance of the voice, in that part of the
chest. These signs left no doubt upon my mind that the indurated or
hepatized portion of the lung had suppurated. My prognosis was
therefore favorable. I assured him that he had not the consumption,
but explained to him the true nature of the case. The only doubt was
from the exhausting nature of the discharge, and the intervention of se-
condary or hectic fever, from the absorption of pus. He was at pre-
sent clear of fever, and his strength was considerable. The indication
was then to favor the discharge of the matter, support the strength, and
promote cicatrization or adhesion. For this purpose I administered nau-
seating doses ofsulp. of copper twice a day, and elixir vitriol as a tonic,
and allowed a nourishing, generous diet. This, with an occasional
dose of blue mass, was all that he took, and he was soon relieved of his
cough and restored to apparent health. But he feels the effect of the
attack to this day, and probably will to the day of his death. I saw
him last winter, and he was pursuing quite a laborious occupation, al-
though he told me that he could not straighten himself without feeling
the bad effects of it.

I have been thus minute in the description of this case, because it is
very rarely that cases recover after hepatization of the lungs, or even
of a portion of one lobe takes place ; but this is the second case in
my own experience in which the signs of hepatization and suppuration
were too unequivocal to be mistaken ; and as it is generally considered

454

The New-Orleans Medical and Surgical Journal.

a hopeless case when such a state of things exist, I wish to show that
there is still a reasonable ground not only for hope, but by a persever-
ance in the use of the proper means, we must succeed.

There is a remarkable circumstance connected with the pneumonias
of this country ; that is, that in nine-tenths of the cases the right lobe
is the one most affected. This must be owing to its contiguity, and
sympathy with the liver ; and is the reverse of what obtains when
the stomach or heart is affected ; for Stokes in his lectures on this sub-
ject observes, " As far as my observation goes, I would say, that when
disease of the gastro-intestinal surface is followed by an affection of the
lung, the morbid action generally takes place in the left lung and in its
lower lobe. There seems to be a greater sympathy between the left
lung and the stomach, than the right, and you should therefore direct
your attention particularly to the left side of the chest. It is a curious
fact, that inflammation of the lower part of the left lobe is very fre-
quently connected with pericarditis and gastritis. There seems to ex-
ist a very remarkable sympathy between organs on the same side of
the body. This is a curious fact, and demands some other explana-
tion besides that which was given by Mr. Hunter, who attributed it to
contiguity of position."

I shall now proceed to consider the use of blood-letting in the well
marked primary inflammatory affections, in which the lungs are not
involved, causing what is called sympathetic or symptomatic fever.
The principles which should govern us in these cases are different from
those which should guide us in the use of the remedy in the idiopathic
fevers ; the rule in this case being to continue the loss of blood until
either the pulse is reduced, or giddiness and faintness are felt, or the
local symptoms are decidedly relieved. The quantity of blood which
should be taken in such cases, then, can never be prescribed before-
hand. We sometimes meet with cases, in which the symptoms of in-
flammation, in its early stage, both local and general, either continue
more obstinately, or occur more frequently, than usual, and in these
cases it is of much importance to be aware how far the remedy may
be carried with good effect ; and it may be confidently stated that no
cases afford a more pleasing retrospect than those in which the cautious
perseverance in the use of this " summum remedium in maximis mor-
bis," has been ultimately rewarded with complete success. With this
view I will introduce one more case.

Mason, a colored man, aged about 25, naturally of a strong constitu-
tion, but abused by irregular habits, complained to his master of pain in
tfrp l?apk, and what he called the gravel — an inclination to make water

Dr. Clow on Blood-letting.

455

without the power. His master directed him to come to me, suppos-
ing that I was at home. But not finding me, the boy took a horse and
started after me, and followed me to different places until he rode some
ten or twelve miles without finding me. He then started back to town,
but was compelled to stop on account of the pain he suffered. On my
return I found him at a house near the road, in the most excrutiating
agony. He could neither sit, lie nor stand, but was walking about in
a half bent posture, moaning most piteously. Supposing it was the
gravel, he desired me to draw off his water. I introduced the catheter,
but found no water. It was a suppression and not a retention of urine.
Upon examination, I found every evidence of acute renal inflammation.
I immediately corded both arms, and from one I took a pint tin cupful,
and from the other a pint bowlful ; this produced no impression, either
on the pulse, except to increase its volume and strength, or on the dis-
ease. I then put under a quart tin pan, and let both arms bleed into
that, and took it full, without making any decided impression. Deter-
mined to make an impression before I stopped, I then made him go out
of the house, and let both arms bleed on the ground until I had taken
nearly a quart, as near as I could judge, before there was any effect
produced; he then complained of feeling faint, and his pulse became
softer and smaller; he however went back into the house without faint-
ing. I then administered blue mass and opium, and put him into warm
water, and gave him parsley tea, and before I left, which was some four
hours from the time I first saw him, he urinated freely and expressed
himself as being entirely relieved from pain. On the next day, late in
the evening, he rode to town, and recovered without taking any more
medicine. The appearance of the blood in this case was so remarka-
able as to attract my special attention. That in the two first cups had
the thickest buff coat that I had ever seen ; it wTas at least three quar-
ters of an inch thick, firm and transparent ; in fact the whole clot ap-
peared to be a mass of complete fibrine, and when turned out of the
cups retained their shape like cakes of jelly.

In regard to the buffy coat in the blood, there are occasional anoma-
lies which are not yet understood. I believe, however, that they de-
pend on the condition of the blood at the outset of the disease. If the
blood is well arterialized and healthy at the commencement of an acute
inflammatory attack, the local symptoms will be more intense, and the
general reaction will run high ; and hence the quantity ofcoagulable
lymph in the blood will be augmented. But when the blood is in a
poor condition, as in many of the complex cases of autumnal and win-
ter fevers, combined with local inflammation, instead of a thick, firm,

456

The New-Orleans Medical and Surgical Journal.

buffy coat, we have merely a deposit of flocculent albuminous shreds.
This state of the blood is unfavorable to a speedy termination of the in-
flammation, at least in health, but it may terminate very speedily in
death — for the only useful or reparatory purpose which inflammation
serves in the animal economy is this, that it either throws out or cir-
cumscribes irritating substances, closes wounds, and repairs other
breaches of structure, and in order to do this, it is necessary that the
blood shall possess certain vital properties, to enable it to undergo the
vital changes which are essential to fulfil these purposes. For instance,
if the blood contains the necessary constituents, we see the lymph
thrown out of vessels in a state of inflammation, gradually becoming
concrete, and taking the form of flakes, and then of membrane, and
finally form elongated cells, into which the blood of the neighboring tex-
ture is received, and in which it continues its motion ; we can only say
that this lymph exhibits vital properties, similar to those by which the
original organization of the germinal membrane of the ovum is deter-
mined. But it is important to observe, that this vital property resides
in that effusion only, and if the blood does not possess the necessary
constituents to produce that effusion, it can never take place. For not-
withstanding some doubts which have been expressed upon the subject,
it seems to be pretty well ascertained, that neither blood itself nor any
other effusion from uninflamed vessels, nor purulent matter, nor the
effusion from certain varieties of inflammation, are capable of thus be-
coming vascular and organized. But when inflammation supervenes,
in plethoric habits, and in sanguine temperaments, we see coagulable
lymph formed in such quantities that its deposition causes disorganiza-
tion in the very textures that it was intended to repair. We then find
that an aggregation takes place towards the centre of these effusions,
and another vital change takes place, and a new secretion, or rather
excretion, because destined to be discharged from the body, is estab-
lished ; and pus or purulent matter is thrown out. This effect of in-
flammation, although it may be favored by exposure to air, is not de-
pendent upon that circumstance, as was supposed by Mr. Hunter, for
we know that it is formed in deep-seated abscesses, and in the vessels
of an inflamed part ; and according to Andral, in the coagula in the
large vessels, and the heart, when there has been no abscess or sup-
purating surface in the body; and when inflammation has existed for
some time in any important organ in the body, globules of pus may be
recognized in the blood.

I think then that we are warranted in the conclusion, that this pro-
cess is intended by nature as a means of throwing off the coagulable

Dr. Clow on Blood-letting.

457

lymph which is no longer needed in the reparative process : for this
change is necessary as a preliminary condition to all absorption of
portions of the living body itself, whether in the living or the dead
state.

The agents employed in this absortion are now generally admitted
to be the veins, at least as much as the lymphatic vessels ; and ac-
cording to the most recent anatomical researches, both of these sets of
vessels are filled in the same way, viz., by lateral transudation ; and
if the quantity is not excessive, it is thrown out without passing into
the arterial system.

Now, the practical indications to be gathered from these facts and
deductions are obvious and conclusive. In the first place, where the
condition of the patient, when attacked with inflammatory affections, is
of that robust and vigorous character which indicates a healthy con-
dition of the blood, the indication would be to take blood in a full stream
and in a large quantity from one orifice, so as to reduce the quantity
of arterial blood, and at the same time arrest the tendency to an un-
due formation of coagulable lymph, and in doing this you will subdue
arterial excitement. And with this indication in view, I have no doubt
but that arteriotomy might sometimes be practised with advantage. But
on the other hand, when the inflammatory reaction is slight, its local
effects inconsiderable, and the fever attending it adynamic or typhoid,
the indication evidently is to take blood from the venous system, and
to promote, by stimulants and a nutritious diet, that condition of the
blood which in the other case is in excess, i. e., the fibrinated condition.

This treatment is applicable to all the varieties and complications of
inflammation, from the simplest erythema to the most complicated of
the contagious exanthemata ; in all of which we have the varieties
characterized by the terms simple and malignant.

My preseut limits will not pormit me to illustrate this with cases ;
but I intend hereafter, if an opportunity is permitted, to furnish an ar-
ticle on the causes, remote and proximate, of idiopatic fevers, and give
my plan of treatment with illustrative cases.

458 The New-Orleans Medical and Surgical Journal.

IV.— THE CHEMISTRY, PHYSICS AND VITALITY OF ORGANIC

CELLS.

Introductory Lecture, delivered November 16, 1852, in the Medical College*

BY J. L. RIDDELL. M. D.
Prof. Chemistry in Med. Dep. Univer. La.

Gentlemen — With feelings of pleasure, mingled with befitting sen-
timents of gratitude to the great Ruler of Nature, I tender you this,
my introductory salutation. It is pleasant to behold before me, as I
now do, the familiar faces of many who have unfalteringly accompanied
me through former courses of lectures, on the science which it is my
duty here to teach. It is also pleasant to behold the goodly recruit of
new students in attendance, in whose society I confidently promise my-
self the same high tone of mental pleasure which I have enjoyed with
their predecessors. And, that we yet live, in the enjoyment of mental
and bodily health, permitting us still to canvass and admire the beau-
ties and the wonders of nature, is sufficient to impress the reflecting
mind with feelings of gratitude.

Custom, as you are aware, gives considerable latitude to the oral
teacher, if he choose to avail himself of it, in his introductory discourse.
Therefore, if in the succeeding hour, I shall at times introduce to your
notice some matters not strictly chemical, you will please to consider
such seeming digressions as fully sustained by precedent.

I shall attempt to present, for your consideration, some account of
the state of our knowledge respecting the physics, the chemistry, and
the vitality of organic cells.

General form and structure of Organic Cells. The simplest as well
as the minutest forms invested with life, within our cognizance, are
exceedingly minute microscopic cells. Hollow spheroid, rounded bag,
or saccule, are expressions which more plainly and more definitely
convey the meaning intended by the word cell. These saccules, which
in general may be likened to a bladder without the neck, are, when
living, filled with liquid and organized contents ; the latter being some-
times, but not always, attached internally to the cell membrane, and
consisting commonly of smaller saccules or vesicles, of a structure on
a smaller scale, apparently similar to the containing cell. [Here seve-
ral drawings were shown illustrative of the general structure of cells.]
I am satisfied, from unnumbered careful observations directed to that
point, that living cells are never seen to be truly simple ; but always to
contain within them more or less organized vesicular structure. The

De. Riddell on Organic Cells* 459

cell which has ceased to be vitally active, like the rind of an orange,
the shell of an egg, or like an empty bottle, may perhaps be entirely
devoid of organized contents. But the true essential structure of liv*
ing cells is no more to be learned from such, than the anatomy of the
bowels from an eviscerated mummy.

Arrangement of Cell Contents. The organized cell contents, whe-
ther consisting of irresolvable points, granules, vesicles, nucleoli or
nuclei, are observed in different cells, and at different times in the same
cell, to present the following diversities of arrangement :

1. Aggregated together into an adherent granular or vesicular mass,
and having an attachment, most commonly parietal, to the containing
cell membrane.

2. Aggregated, mutually adherent, but free, having no attachment to
the cell membrane.

3. Separate and free ; the individual granules or nucleoli floating
independently in the fluid contained in the cell.

In the progress of the performance of their different vital functions,
the inducellular contents are seen to pass from one of these conditions
to another. The vital force pertaining to the vesicles appears to be
more exalted in the segregated or independent, and less in the aggre-
gated or attached condition.

The foregoing statements respecting vesicles, etc., as the contents of
cells, are mostly applicable to the cells themselves. They are some-
times aggregated and adherent, forming tissues ; sometimes separated
and free, as exemplified by blood corpuscles ; and to the free cells, as
blood, spermatozoa, etc., the most active and exalted condition of vital-
ity pertains. In the aggregated state, they are frequently seen to have
lost their rounded form ; and by mutual pressure, to have become poly,
hedral.

Habitat. If you ask me to point you out actual organic cells, by
way of illustration, I say to you, bring into the field of a good micros-
cope any portion of the vast diversity of organized and living substan-
ces, abroad in nature, from the rank slime of the sickly marsh to the
warm blood which courses in your own veins, and at every trial you
will behold the cells of which I am speaking. In nearly all natural
waters upon the face of the earth, minute forms of life abound, which
in all respects observable, can be likened to mere cells, floating free
and independent in their native element. With them, other cells,
joined end to end, forming moniliform or jointed filaments, do also
abound ; as do likewise, others, associated together in a manner more

460

The New-Orleans Medical and Surgical Journal

complicated. The air we breathe is charged with cells of wonderful
minuteness, the germs of alleged fortuitous growths, the spores of cryp-*
togamic vegetation, and the prolific source of pestilential maladies.
The mould that delights in damp and darkness, the harbinger of disso-
lution and decay, may be seen to consist of extremely delicate cells?
planted one upon another* The whole tissue of the Fungi, or mush-
rooms, is made up of organic cells, somewhat as walls are made up of
bricks. Cells constitute the principal structure in all parts of all plants.
In the living state they are most conveniently observable in the leaves,
flowers, fruit and cambium. Cells also constitute the principal struc-
ture in the early embryonic condition of animals ; and in all stages
they can be observed in most of the animal tissues ; best perhaps in the
mucous, epidermic, glandular and cartilaginous structures.

Size. In general, organic cells are individually truly microscopic
objects, being by far too minute for unassisted vision. Larger cells are
seen in animal, than in vegetable tissues. In every species of organ-
ism, however, cells or utricles do abundantly occur, of a minuteness of
size beyond the power of our microscopes clearly to define. They are
seen satisfactorily to be as small as 1-100,000 of an inch in diameter ;
and on the other hand, in vegetable structure, as large as 1-30 of an
inch,* the average of vegetable cells being near 1-500 of an inch in
diameter.

Human blood corpuscles, which are vital cells, are less in diameter than
1-3000 of an inch. Animal ova are perfectly well characterized cells,
and they afford us, as in the eggs of birds, perhaps the largest known
samples of that structure.

Chemical Composition, in connection with Structure. In respect to
the chemical composition of living cells, it may be safely said that it is
complex ; oxygen, hydrogen, carbon and nitrogen, being always pre-
sent, and in such high proportions as to be not expressible with cer-
tainty by chemical formulae. Phosphorus, sulphur, iron, manganese,
calcium, sodium, magnesium, etc., in essential proportions, are, in dif-
ferent classes of cells, often met with. I think that protoplasmic or
vitally active cells consist mainly of those complex nitrogenous substan-
ces denominated protein compounds. The number of the proteine and
proteinoid nitrogenous substances thus naturally occurring must be very
great, although very few have as yet been chemically defined. [Here
diagrams were shown, setting forth the chemical composition of pro-
tein, albumen, fibrin, casein, glutin, binoxide of proteine, tritoxide of

* Gray's Bot. Text Book, p. 26.

Dr, Riddell on Organic Cells.

461

proteine, gelatinous substances, coloring matter of blood, and chlo-
rophyle.]

The primordial living cell, or vital cell lining, sometimes called the
protoplasm, whether examined in animal or vegetable tissues, manifests
in all respects nearly the same essential characteristics ; possessing,
indeed, all the wonderful prerogatives of animal life. This primor-
dial living cell usually becomes invested, at an early stage, with a mem-
branous covering, of a different nature and composition in different
instances ; a structure which, like the walls of the contained living
cell, is permeable to liquid ; permitting of the occurrence of the physi-
cal phenomena of endosmose and exosmose ; but which, by itself, does,
not seem to possess vitality. This secondary non-vital cell, most fre-
quently endures, long after its vital contents have become inert, suffered
change or dissolution, or perhaps entirely disappeared by absorption.
Now the ehemical composition of the non-vital, comparatively perma-
nent cells, is exceedingly various, and often comparatively simple. Of
such nature is cellulose, and starch ; the characteristic components of
most vegetable tissues. [The formula

C12 HO 0 9 + water, for cellulose ; and
C12 HIO 010 for starch,

C12 H 8 010 for pectin, were explained.]

Of such nature are many epidermic, epithelial and cartilaginous cells
in the animal structure.

Functions of Cells. The functions performed by organic cells may
be regarded as threefold — purely physical, chemical and vital. Their
most important physical function depends upon their permeability to
liquids. No sensible pores exist in the cell membrane ; yet a ready
transit is afforded to water and watery solutions, in accordance with
the laws of endosmosis. Whatever thus traverses a cell membrane,
must apparently be in a complete state oi solution, and devoid of all
organization. The blastema, in what condition soever it may be pre-
sented at the exterior surface of the cell, must become (if not alreadv
in that condition) apparently deorganized and perfectly fluid.* The

* We cannot, in. the present state of our knowledge, positively affirm or deny, that
invisible organized particles find transit through organic membranes. For aught we
know, the intermolecular spaces occurring in the ultimate structure of the walls of
cells and vesicles, maybe propprtionate in width somewhat, to the size of the cell or
vesicle, or to its stage of development, from the minutest transcendental germ to the
adult cell. If so, we might expect to find in the more minute corpuscles a more in-
tense vital force, and a greater power of resisting chemical agents ; precisely what
we observe in the acticn of vinegar, alkalies, etc., on blood. The intensity of the
endosmotic power would be found to vary inversely, while the facility of endosmotic
transmission would vary directly as the size of the corpuscle. Admitting the hypo-

462 The New-Orleans Medical and Surgical Journal,

chemical changes and transformation attendant upon cell life, are nu-
merous, varied, complex, and highly important. Besides the principal
ultimate elements, which I have already named, as contributing to the
composition of cells, many others of the so called inorganic elements
take part in their chemical operations. In fact an organic cell may
be appropriately regarded as a skilfully constructed and most efficient
chemical apparatus ; in which not merely the ordinary forces of brute
matter manifest themselves; but other more exalted forces, flowing ap-
parently from vitality, and unknown in inorganic chemistry, are brought
efficiently into play, causing the union of elements in an extraordinary,
and frequently complex manner, giving rise to the so called organic
compounds, which are beyond the reach of human art to imitate. These
organic compounds are sometimes found as a part of the cell contents,
sometimes intercellularly or between the ceils, and sometimes penetrat-
ing and even replacing the cell wall. In such apparatus, and by such
means, all the material transformations of organic life, so wonderful to
contemplate, are said to be effected.

The vital functions of cells, most important to be mentioned at this
time, pertain to their development, growth and decay. The vitally ac-
tive adult cells of an organism are, for many reasons, presumed to be
very short lived — a few days or weeks at most, unless prolonged by
dormancy ; the vital functions of an animal or plant being performed
successively by adequate recruits of newly developed cells, the progeny
of the former. The old and useless protoplasmic cell membrane suffers
disintegration, dissolution and removal ; its available material is con-
tributed for the nutrition of its successors, and its effete matter returned
to the earth and atmosphere, whence it was originally derived — •
there to be broken up into its primordial elements, — to be purified
indeed by complete decay.

Origin and Development — Limits of Vision. Notwithstanding the
prevalence of a contrary opinion, with some writers of note, for my-
self, I am satisfied that vital cells never originate in any other way than
as the progeny of pre-existing organisms. The nucleoli, granules, or
utricles, from which, as germs, they are primarily developed, no doubt
from their minuteness, often far transcend our power of direct observa-
tion. Dr. W. J. Burnett of Boston, who has made many valuable mi-
thesis, which is not improbable, it would then be possible to understand how exceed-
ingly minute organic germs could find transit through an organic membrane, floating
through the intermolecular spaces, in an endosmotic liquid current. I am inclined to
believe such does occur ; for I have often seen diseased animal cells, seemingly en-
tire, yet containing inducellular growths, apparently abnormal or parasitic. Malari-
ous organized poisons may thus penetrate, and by their parasitic development, vitiate
the corpuscles of human blood.

Dr. Ridddel on Organic Cells.

463

croscopic observations upon embryology, seems to think (Proceed. Am.
Asso., V. 131, in a note), that the smallest possible utricles are about
the 1-200,000 of an inch in diameter. Other writers have assigned
even a larger limit. But I can perceive nothing to sustain their views,
as indicating the limits assigned. Yet, considering that there must be
a limit in size to the chemical elements of matter, it would follow that
there must also be a limit, far larger of course, to the size of the small-
est possible organic and vital particles. It may be useful, in connection
with this subject, to determine, if possible, the limits to human vision.
According to Ehrenberg (Taylor's Sci. Mem. I. 577), the unassisted eye
can, as a limit, clearly perceive a square or round substance, white
upon a surface of black, or black upon white, about 1-40 of a Paris
line in diameter. This is equal to near .002*25 English inch ; and tak-
ing the distance of clearest vision at 10 inches, the angular diameter
of the minimum body seen would be 45". As to the practical limits
of microscopic vision, considerable diversity of opinion prevails. The
celebrated Robert Brown assumed, in 1828 (Ehr. in Taylor's Sci. Mem.
I. 570), that a body less than 1-30,000 of an inch could not be seen.
With the best instruments of the present day, we can look much
deeper into microscopic nature. I am satisfied we can clearly define
an object, whose diameter is somewhat less than 1 100,000 of an inch,
andean perceive objects still more minute. With a magnifying power
of 1000 diameters, which is perhaps as great as can be advantageously
used in such researches, the body 1-100,000 of an inch in diameter,
would be seen to subtend an angle of 3', which is four times as great
an angle as that concerned in the limit of vision before mentioned for
the unassisted eye — demonstrating that the quality of the optical
arrangements in the best microscopes is greatly inferior to that of the
human eye.

Now I have determined, indirectly, of course, that the space occu-
pied by a single particle of water, the smallest possible, [H O] ap-
proaches and cannot be less than .000000002762 inch in diameter,
say in round numbers 1-400,000,000 of an inch in diameter. (Constitu-
tion of matter, IT 76. p. 17.) Suppose, for the sake of theoretical compa-
rison, that the smallest vital corpuscle were one million times the size,
or in other words, one hundred times the diameter, of such a particle of
water. Our present microscopes of 1000 diameters, are limited to the
clear definition, say of bodies 1-100,000 of an inch in diameter ; now,
if a microscope could be made, having the same angular definition, 3',
and magnifying 40,000 diameters, such minimum vital corpuscle could
be made cognizable to visual observation. But, it is useless to think

464 The New-Orleans Medical and Surgical Journal.

of ever attaining a tithe, or even a twentieth part of such excellence in
the microscope. We may therefore never hope to behold an ultimate
vital corpuscle, or a truly single or simple living cell.

As to the genesis or multiplication of cells, three methods, alleged
by some to be essentially different, have been witnessed by microsco-
pic observers. These are, 1, increase by fission or division, merisma-
tic multiplication or fissiparous generation ; — 2, internal development,
or endogenous generation ; — 3, external development, or exogenous ge-
neration. The fissiparous multiplication can be satisfactorily observed
in microscopic algae. From the vital or protoplasmic lining of the cell
cavity, an annular membrane starts, and growing centripetally, finally
meets and closes in the centre, thus making two cells out of one. The
yolk of an egg undergoes the process of segmentation, on essentially
the same principles. Dr. Burnett reports to have witnessed the
same mode of increase in epithelial and pus cells from the ani-
mal system.

The endogenous method of multiplication is that most frequently ob-
served. The vesicles contained in the cell become enlarged by growth,
and perhaps multiplied by fission, until at length the parent cell is rup-
tured, and finally disintegrated and absorbed. The vesicles thus made
free, assume in turn all the cell characters, and finally disappear, after
giving birth to a like progeny. At the first view, it might appear that
an unlimited number of generations of cells were wrapped within each
other, and that the successive crops of cells were produced by the
mere unfolding, or rather successive growth and enlargement of the dif-
ferent contained orders of nuclei. Such, to an unknown extent doubt-
less, does actually occur. But upon second thought, it must be appar-
ent, that as the germinal nuclei necessarily have a minimum limit of
size, unknown though it be, only a limited number of generations can
at any one time actually constitute the inducellular contents. Recurr-
ino- to what we know of fissiparous multiplication, it becomes probable
that the primordial cell germs are produced and increased in number,
by the process of fission or division. [Drawings were shown, exhibit-
ing the division of a cell of Zygnema by fission ; and others illus-
trating the endogenous development, as observed in the embryo tad-
pole.]

The exogenous development of ceils is, in my opinion, more appar-
ent than real. A vesicle appears to protrude from the walls of a cell
externally, and increasing in size, becomes at length as large as the
cell from which it springs, and ready in turn to contribute an offset.
Should these successive formations remain attached to each other, a

Dr. Riddell on Organic Cells.

4G5

jointed or beaded filament, simple or branching, as the case may be, is
the result. Now, in these cases a close scrutiny leaves in my mind
little or no doubt that the developing germ really originates within the
cell, and is therefore of endogenous origin. In its development, it
pushes itself through and beyond the cell wall, doubtless carrying be-
fore it a layer of the protoplasm, and hence its apparently exogenous
character. The so called exogenous mode of development may be sa-
tisfactorily seen in the Torula, or yeast plant, and in many of the mi-
croscopic algae and fungi. [Drawings of Torula were shown and ex-
plained.]

For most of our knowledge respecting the structure and functions of
vegetable cells, we are indebted to vegetable physiologists, and especi-
ally to Prof. M. J. Schleiden, author of " Phytogenesis," (Taylor Sci.
Mem. II. 281 et seq.) and to Prof. Hugo Mohl. (Taylor Sci. Mem.
IV. p. 91 et seq.) Mohl was the first to observe and duly appreciate
in vegetable structure, the important functions, the high organization,
and the fugacious nature of the active vital cell membrane, denomina-
ted by him the protoplasm, or primordial utricle. In 1639 Dr. Schwann
published an able memoir, in which he showed that the doctrines of
Schleiden, respecting vegetable cells, were in many respects applicable
to animal tissues. Among many important and well sustained facts,
the memoir of Schwann contains other matters, which later observa-
tions, with better instruments than existed when he wrote, have shown
to be untenable. His grand hypothesis of the origin of organic germs
and cells, has, in my opinion, no foundation to rest upon. He sees an
analogy between inorganic crystals and vital corpuscles ; the materials
of both, he is inclined to think, being deposited from a state of solution,
in obedience to the laws of brute matter. But while true crystals are
impermeable to the mother liquor, and can therefore increase in size
superficially only, and therefore have facets and angles ; the vital crys-
tals remain permeable to the fluid in which they are formed, and can
therefore increase in size, not only by new external layers, but by in-
ternal and interstitial deposition. Hence the rounded form. Hence
the more or less hollow cavity. For my part, I have no objection to
the physical bearing of all these considerations ; — but considering the
specific difference, the vast diversity, and the wonderful functions of
cells, I feel impelled to acknowledge the influence of what we call vi-
tality, as something more refined and exalted than what we mean by
chemical force ; and so far from perceiving similarity or analogy be-
tween the two cases, it appears to me that there are scarcely points
of even remote resemblance.

466 The New-Orleans Medical and Surgical Journal*

Dr. W. J. Burnett of Boston has accomplished much, in respect to
the more recondite histology of animal tissues. He thinks the ultimate
structure of membranes, filaments, fibres, cells, nuclei, etc., consists of
very minute hollow vesicles, which he calls primordial utricles. Mohl
has pre-occupied that expression with a different meaning. In epithe-
lial and pus cells of animals, he asserts that he has observed the fol-
lowing phenomena pertaining to their development. (Proc. Am. Soc.
III. 261.)

1. A dark point [nucleus] appears in the organizable fluid.

2. This dark point enlarges, becomes hollow, and filled with a clear
liquor.

3. The contained clear liquor becomes cloudy and granular.

4. Dark points appear, [new nucleoli] which develop like 2 and 3,
attended perhaps with the disappearance of the parent cell.

Dr. Leidy of Philadelphia has also contributed to the advancement
of histology [the science of tissues], and from what I have seen, (Dr.
Waring's paper, Am. Jour. Med Sci. Oct. 1852, p. 326), I infer he
follows pretty closely the views of Schwann,

Prof. Ch. Girard, of the Smithsonian Institution, has made some very
interesting and instructive observations on the development of the
germs of Planariae. (Proc. Am. Asso. III. 398.)

Acherson's Experiments. Dr. Acherson, and others since, have ob-
served that an emulsion of oil and albumen results in the formation of
cells, simulating in appearance those of vital production. Considerable
weight has been given to these observations, by many writers, as elu-
cidating the theory of the genesis of organic cells. It is not improba-
ble, that the mutual presence of albumen and oleaginous substances in
the animal system, may constitute a condition favorable to the vital de-
velopment of cells. But we have no reason to suppose that vitality
could attach to a globule of oil, accidentally, as it were, surrounded by
an envelope of chemical albumen. It is even possible to produce a
pseudo cell of similar form, by the contiguity of purely inorganic che-
mical materials. A precipitate simulating an organic membrane en-
sues on mingling a solution of the protosulphate of iron with a solution
of potassa ; and similar results occur with many other solutions (Mul-
der. Chem. Physiol. Fremberg's trans, p. 374).

Contractile and Sentient Tissues. Leaving out of consideration
Mohl's primordial utricle, or vital cell lining, it is doubtful whether a
simple cell membrane has ever been seen to manifest the power of
spontaneous movement ; or to possess by itself the vital qualities of

Dr. Rid dell on Organic Cells.

467

irritability and contractility. There is a structure largely developed in
animals, and not absent in plants, to which these mysterious attributes
pertain. Of such nature is muscular substance, and the vibratile ciliae,
the latter being common to the animal and vegetable kingdoms.
Schwann thinks this structure is of cell origin. Dr. Burnett says that
it probably consists of wonderfully minute utricles or vesicles. My own
opinion is, that the living contractile and sentient tissues, in whatever
form they may appear, are probably prolongations, offsets or modifica-
tions of the substance of the primordial utricle, as defined by Mohl.
This could not be effected in accordance with the current cell theory ;
and therefore it appears to me that the genesis and primitive histology
of the contractile and sentient substances, are, as yet, almost entirely
unknown. In the embryo tadpole, cells appear, actively manifesting
the power to move, by means of vibrating cilias. [A drawing of such
a cell was shown and explained.]

The minutest cell spores of fresh water algae are similarly equipped
with the means of locomotion, which they actively use, as soon as they
are set at liberty. The spermatozoa of animals, smaller than blood
cells in size, swim actively about, by means of an attenuated tail.
Within the cells of the Desmidiae, of algae, of the higher plants, espe-
cially in the petals of flowers, in mucous cells, and in embryonic blood
cells, minute corpuscles are sometimes seen, freely and briskly moving
about.

It was observed by Robert Brown, in 1828, and has since been con-
firmed by almost every microscopist, that very minute particles, as of
gamboge, iodine, albuminate of lead, etc., which do not possess vital-
ity, sometimes manifest a vibratory, irregular movement. The cause
of these, Brownian movements, so called, is rather shrouded in obscu-
rity ; but it may probably be referred, in different instances, to solution,
dissolution, deposition, chemical change, or to permeation — mere mole-
cular changes all. But the inducellular movements I have cited are
probably not all referable to the causes of the Brownian movement. It
is probable that many of these movements are produced by vibratile
ciliae, too minute to be made apparent to vision.

Now, the most patient scrutiny has failed to make out a normal cell
origin for the moving ciliae ; and the same may be asserted of all the
contractile and sentient tissues known to us. [Drawings were ex-
plained, of Zoospores of Oscillaria Aureliana, Riddell. (Euglenia.)
Human spermatozoa, Gamboge particles, and petal cells of Dracopis
amplexicaulis, Cass.}

468 The New^Orleans Medical and Surgical Journal.

Thus the cell theories of Schleiden and Schwann must be considered
as falling short of what has been claimed for them, inasmuch as
they give us no light respecting the histological origin of the contractile
and sentient tissues.

Blood-vessels. The development of blood-vessels presents us with
another signal failure of the cell theory. The stellate cells of Schwann,
which he supposed to become transformed into capillary vessels, are
merely intercellular spaces ; and the blood, impelled into these inter-
cellular spaces,deposits the plastic material around its path, of which the
blood vessel is thus formed. [Enlarged copies of Plates XV. and
XVI. New Orleans Med. and Surg. Jour. Vol. IX. p. 174, for August,
1852, were exhibited and explained, shewing the way in which capillary
blood vessels originate in the tail of a tadpole.]

Peculiarities of Red Blood Cells. The red blood corpuscles of the
vertebrata, are perfectly well characterized composite cells. They
possess a high degree of vitality, and having, as a principal function,
to transport oxygen (probably in a loose state of combination) from the
atmosphere, to all parts of the organism to which they belong, there is
prominently developed within them, a curious, uniformly vesiculated tis-
sue, not obvious in other cells. The central part of the corpuscle, in
human blood, for example, has the ordinary nucleolar structure common
to other animal cells. But the thickened enveloping membrane, or its
thickened protoplasmic lining, abounds with myriads of minute vesicles,
of nearly uniform size, and less than 1-100,000 of an inch in diameter.
In blood corpuscles of the Amphiuma tridactylum, Cuv., which are the
largest known, and which possess analogous structure, this vesiculated
mantle can be clearly made out. I have denominated this structure the
pallium vcsiculatum. It doubtless acts as the carrier of oxygen. (New
Orleans Med. and Surg. Jour. Vol. IX. p. 119.)

Summary. And now, gentlemen, by way of travelling towards a
conclusion to this discourse, I will state to you, that in my opinion, the
several propositions which I shall now present you, while they embody a
partial summary of the present state of our knowledge respecting or-
ganic cells, at the same time are as near the truth as it is possible to
arrive, without further explorations into microscopic nature.

1. That organic cells are composite organisms, the product of vital
development.

2. That each living cell has a vitality independent of others ; and
that the elementary, individual, vital ens, if it has a concrete existence,
can only exist in the transcendantly minute, simple cell germs.

Dr. Riddell on Organic Cells.

469

3. That cells are usually produced by development from cell germs,
the contents of preceding cells.

4. That visible cells are sometimes multiplied by the process of fis-
sion or segmentation,

5. That the unseen, primitive, simple cell germs, are probably al-
ways multiplied by the process of fission or segmentation.

6. That as cells, even while they continue vital, are in one sense
chemical apparatus, and may appropriate chemical materials, and by
chemical transformations, modified or not, by vitality, produce chemical
results, in the form of new compounds, the study of their structure and
functions is indispensable to the student who would properly understand
organic chemistry and physiology.

7. That since there is diversity of chemical composition, not only in
the more simple secondary, but even in the more chemically complex
primary or protoplasmic cell membranes ; and since material difference
of composition insures difference in function, being attended by change
in the elective powers exerted over the materials brought in contact
with the membrane, controlling the quality of the materials permitted
to permeate by endosmotic action, and therefore controlling chemical
and vital products of cell action ; we have a clue to the explanation of
many important vital processes, such as secretion, excretion, and the
accumulation of special cell contents, as of starch, sugar, fatty substan-
ces and morbid products.

8. That, although we have not mastered, and may never fully mas-
ter, vital chemistry, yet by experience we have learned, that as the
composition of the nutrient fluid in contact with cells is made to vary,
a corresponding variation takes place in the chemico-vital products of
cell action. On this consideration depends, in a good degree, the
theory of the operations of medicines upon the animal economy. These
views, for instance, are very well understood and usefully acted upon
by the medical profession, in respect to the different conditions of the
urine, which can be modified or changed with promptitude and cer-
tainty, by the internal administration of remedial agents, on chemical
princples.

9. That, determining by chemical analysis, the nature of the so called
inorganic elements, always present, some predominating here, some
there, in the cells of the different tissues, we are at once put in pos-
session of most valuable knowledge, by the use of which we may fa-
vor and facilitate the healthy growth of new cells in particular tissues.
In exemplification, it has been determined that phosphate of lime oc-
curs in the living cells of man ; and the experience of Prof. Stone and

470 The New-Orleans Medical and Surgical Journal.

others seems to show, that the administration of phosphate of lime
tends to prevent that cell degeneration, which constitutes phthisis, by
aiding to reinstate a healthy cell formation.

Conclusion.' In conclusion, I will offer you a few remarks, relevant
somewhat to the main subject of my discourse,- — upon organic chem-
istry.

Organic chemistry has become a vast and unwieldy science. Nine
tenths of it at this time, at least, concern those factitious compounds,
which never occur in nature, but which are producible by the chemi-
cal art, operating upon organic materials. I would not be thought to
underrate its value, and trust that I do not, when I assert, that the nine
tenths alluded to, contribute much less to the elucidation of physiology
than to increase the general fund of science. Still, organic chemistry
has rendered incalculable aid to physiology. It could not, indeed, be
very widely amiss, to regard physiology as a higher department of or-
ganic chemistry. In some of its chapters it might, properly enough,
be called transcendental chemistry ; just as the calculus bordering upon
metaphysics is called transcendental mathematics.

To pursue vital chemistry with promise of success, the dissecting
instruments, the microscope, and the chemical reagents, must all be at
hand, ready for convenient use. Preliminarily, the student must be
conversant with the elements of chemistry and the elements of physi-
ology. With all the advantages that can be commanded, it will still
frequently happen that the clouds of uncertainty will pertinaciously en-
velop the subject of investigation. Nevertheless, much useful and
practical knowledge will thus be attained. We may learn, for instance,
that hydrochloric acid communicates a purple color to albumen and
other protein compounds, without being able to assign the reason why;
and that cellulose may be distinguished by the use of weak sulphuric
acid and tincture of iodine. That iodine colors starch blue, and pro-
tein compounds brown ; although the rationale of these changes may
elude our enquiry. Single observations may appear to have but little
value ; but accumulated and varied observations will indicate the abode
of truth. Prosecuting, with zeal and perseverance, our explorations
near the present boundaries of our knowledge, little by little the dark
mists which hem in our view will retire before us ; more and still more
distinct and admirable will appear the true lineaments of nature. Thus
shall the sun of science, ascending towards the zenith, shed abroad a
more glorious effulgence, and contribute its sublime rays to the features
of the still widening area of human knowledge.

Dr. Riley on Ncevus Matemus.

471

V.— SINGULAR CASE OF NCEVUS MATERNUS.

BY R. RILEY, M. D., MISSISSIPPI.

A. Hester, M. D.

Dear Sir — The object of a public journalist should be two-fold,
viz., to propagate truth and expose error ; and contributors to science
should be actuated by the same noble purpose. Starting, then, with
this broad hypothesis, you might readily be led to suppose that in ven-
turing to claim a space in your excellent Journal, I had some important
truth to communicate, or a great error to expose. But such is not the
case. My purpose is simply to describe a very interesting phenomenon
that came under my observation recently, in the person of an infant six
months old. At birth it was disfigured by a mark — ticevus matemus
— covering the whole of the left side of its face ; from above the left
supercilium, involving the whole of the eyes to the inner canthus ; from
which point it passes diagonally across the nose, to the right ala, em-
bracing the septum and the whole of the left ala, thence downwardsMn-
volving the left two thirds of the labii superiores, the angle of the mouth
of that side, and the chin as far as the symphysis, whence it turned di-
agonally backwards and downwards on the side of the neck to within
an inch of the clavicle. A small spot, of the size of a half dime, is
perceptible upon the right eyebrow, but not so distinct as upon the left.
The general appearance of the mark is that of an extensive bruise, of
a deep scarlet color, with the appearance of extravnsated blood, and
considerable swelling; several points being raised above the general
level of the surface, particularly the eyebrow, upper lip and nose. In-
numerable capillary veins, greatly enlarged, are seen passing in a tor-
tuous manner throughout its whole extent.

It is needless to say that the disfiguration was awful ; but otherwise
the patient is a remarkably large, fine looking child. Parts of the mark,
particularly upon the lip and throat, were early disposed to ulcerate,
and about the third week of its existence the little patient had a severe
attack of stomatitis, which yielded readily to medical treatment, as did
the ulcers above mentioned ; when a sympathetic affection of the throat
supervened, which continued as long as the ulcers remained healed, but
subsided as soon as they were permitted to open again, which happened
more than once. This state of things continued, with but little change
until about the middle of September, when the little patient had an at-
tack of intermittent fever, and in a short time the mark, throughout its
whole extent, became highly inflamed, ulcerated, and about the fourth
day of the attack, became the seat of passive hemorrhage, exuding a
sero-sanguineous fluid, of an exceedingly acrid nature, which excoria-

472 The New-Orleans Medical and Surgical Journal.

ted the surrounding parts, when permitted to come in contact with
them.

About the tenth day a dark slough formed, which came away on the
sixteenth day, about which time it was seized with convulsions, (having
six in one day, the last of which was as severe as I ever witnessed, af-
fecting principally the right side ; the contractions of the muscles be-
ing so great as to produce partial luxation of the head of the Radius)
which resulted in paralysis of the right side — complete hemiphlegia.
The sloughing process still goes on; the structure of the supercilium
is completely destroyed, as is the left ala and septum of the nose ; the
bone of the supra orbital ridge was left exposed to view when the slough
was dislodged.

The present character of the ulcer is evidently malignant ; not
spreading laterally, but eating, excavating the deeper seated structures.
Its limit is well defined, with a hard elevated edge, of a pearly grey co-
lor. It still discharges a thin ichorous fluid, exceedingly foetid. The
strength of the little patient is rapidly declining. Diarrhoea has super-
vened, and the countenance has assumed that wan and sallow appear-
ance so characteristic of cancer.

I would remark, in conclusion, that the parents of the child are re-
markably healthy — have several other children, all of whom are bloom-
ing and healthy.

P. S. The child has died since writing the above.

October 25th, 1852.

VI.— REPORT OF THE COMMITTEE ON MIDWIFERY AND THE
DISEASES OF WOMEN AND CHILDREN.

BY WM. P. HORT, M. D. CHAIRMAN.

[The following paper was written by the late lamented Dr. W. P. Hort,
and read by Dr. Browning to the Louisiana State Medical Society, at one
of its sittings during last winter ; and as the last effort of his singularly
exact and logical mind, we feel it our duty to lay the Report before the
Profession. As we cannot make room for the entire article in this num-
ber, we shall continue and conclude it in our March issue. Ed.]

Of the molecular matter of which this earth is composed, one portion
is inert, until set in motion by some external agent ; the other is en-
dowed with what is denominated vitality. The physical organization
of the former has been, and still is determined by chemical action, by
electrical influences, by earthquakes and volcanic eruptions, and by the
abrasion and transfer of rocks and soils by heavy rains, and the sudden
melting of snow on the plains or in the mountains.

Dr. Hort's Report on Midwifery.

473

The latter differs essentially and radically from the foregoing, inas-
much as matter endowed with vitality possesses within itself the power
of motion, and above all, the capacity of propagating or reproducing its
like ; besides presenting a variety of wonderful phenomena, illustrative
and characteristic of life, to our clear conviction and full satisfaction.
We at once recognize vitality by these phenomena ; yet, however we
may be disposed to theorise on the subject, we really are as incapable
of comprehending what life is in the abstract, as we are of grasp-
ing the overwhelming idea of Eternity, or that of illimitable and bound-
less space.

Having drawn as briefly as possible the distinction between mere
molecular matter and the living entity, whether it be a plant or an ani-
mal, we must now confine ourselves to one peculiar and characteristic
phenomenon — we mean the internal power of generation and propaga-
tion.

Amongst plants, there are several ways of propagation — by the seed,
by cuttings, and by grafting.* And in the animal creation, we may no-
tice two general modes — the viviparous and the oviparous. As a gen-
eral rule, there must be actual contact between the male and the fe-
male, but there are striking exceptions — as in the case of the frog and
other reptiles, where the eggs are fecundated by the male, after their
expulsion from the body of the female. Another exception is seen in
fishes ; most of them lay eggs, which are matured and hatched out of
their body ; others are cartilaginous and viviparous ; while according
to Home, hermaphrodites may be found amongst fishes. He affirms
that in the lamprey there is both spawn and milt.

In the minute infusoria, the subjects of microscopic observation, the
mode of fecundation is unknown, but the fact of propagation can be
demonstrated. Some of the globular monads, and of the vorticellae,
increase by spontaneous and equal division. We first observe an equa-
torial band encircling the lining globule, which is drawn more and more
tight, until a complete separation is effected, until each portion becomes
an independent living entity, which, in its turn, is like the parent, bi-
sected. And the mysterious propagation goes on indefinitely. The
Monasuva consists of a cluster of four or five globules or corpuscles,
by the spontaneous separation of which the species is propagated. The
Volvox Globator consists of a spherical membraneous sac, filled with
liquid, in which float many diminutive globules like itself — even to the

* In the former case there are male and female organs, generally on differ-
ent plants ; yet sometimes both are found in the same plant.

474 The New-Orleans Medical and Surgical Journal.

fifth generation has been seen, by accurate and diligent observers, in
the same individual animalcule. It is to this species of the infusoria
that the living entities in the blood bear so close an affinity. The re-
semblance is perfect, except that within the blood corpuscles not more
than one generation has as yet been discovered. From thirty to fifty
have been seen in the parent sac. The mode of propagation is the
same in both cases ; in due time one or more of the contained monads,
or minute corpuscles, or globules, will produce great tension on the side
of the parent sac, until at length it bursts through the obstruction into
independent existences.

Ehrenberg informs us that he has seen the ova of animalcules ex-
cluded, in the form of minute globules, the twelfth thousandth part of
an inch in diameter, and that when they had grown to the size of the
seventeenth hundredth part of an inch, or seven times their original
diameter, they were distinctly seen to excite currents and swallow food.
He also claims to have detected the offspring of the Rotifera Vulgaris,
perfectly formed, moving within the parent animalcule, and finally ex-
cluded in a living state, establishing the fact that the former were ovi-
perous and the latter viviparous. He says nothing of the mode of
development of the living entity from ova in the first instance. He
leaves that to nature, and probably he is right.

We would remark that this Rotifera Vulgaris, in its mode of propa-
gation, presents the closest analogy to the living entities in the blood.
There are other species of the infusoria which resemble the Hydra, or
connecting link between the animal and vegetable creation. They are
called gemmiparous, because they produce granules, (like the budding
of a plant) which shoot forth from the side of the parent, and are soon
provided with cilia, enabling them, when separated, to provide for their
own subsistence.

This introduction may probably be deemed irrelevant ; but we have
alluded to the different modes of propagation amongst plants, fishes,
reptiles and minute microscopic entities, because we deem the subject
of internal propagation, with all its varieties, as to the peculiarity and
principle, as one and inseparable from the most minute of God's crea-
tures, to the largest, or the most perfect in point of organization and
intellectual endowment.

It is unnecessary to advert to those instances of fecundation and
propagation amongst animals, with which every observing man must be
familiar, until we come to speak of man, the highest of the order Mam-
malia. Of the inferior animals, Nature is the universal and almost

Dr. Hort's Report on Midwifery.

475

unerring midwife. But man, who stands at the head of created, living
entities on this earth, too often requires the assistance of Art, to carry
on the propagation of the species.

Midwifery has been well defined to be the art of aiding and facili-
tating the birth of a child, and its appurtenances, and of providing for
the safety of the mother, during and after her delivery. It is derived
from two German words, Mit, with, and Weib, wife. It requires a
thorough knowledge of anatomical, physiological and pathological sci-
ence. We have very little information on this subject, when we go
back to remote ages, but it is probable that it has been practised from
the earliest ages of mankind, at least where there was any semblance
of civilization. It was doubtless at first very defective, and only re-
sorted to on the most urgent occasions. We know that amongst the
most cultivated nations of antiquity this art was very imperfectly un-
derstood.

For this, however, a sufficient reason may be assigned. It is ad-
mitted by all well educated men that the dawn of civilization took place
somewhere in the East, where the soil is fertile and the climate luxuri-
ous. Now, it is well known that women suffer less when pregnant,
and give birth to their children with far greater facility in a warm and
genial climate, than in cold northern regions. Hence the reason for
the art not existing — it was not cultivated.

The first allusion to any difficulty in propagating the human species,
is found in the third chapter of Genesis, at the 16th verse. Deity is
there represented as speaking to Eve, on account of disobedience to
the divine law.

"Unto the woman he said, I will greatly multiply thy sorrow and thy con-
ception— in sorrow thou shalt bring- forth children."

In the 35th chapter of Genesis it is said, that Rachel, on the road
between Bethel and Eprath travailed and had hard labor, and that the
midwife said unto her, Fear not, thou shalt have this son also. She
died, however, and this is the first recorded instance of a woman dying
in parturition.

It is to be inferred that the Egyptians had no regular midwives, since
when Pharaoh wished to destroy the male children of the Hebrews,
he issued his orders accordingly to the Jewish midwives. It appears
that there were but two of them, whence we conclude that there was
seldom necessity for their assistance. They refused to comply with
the cruel and inhuman command of the Egyptian monarch, and gave

476

The New-Orleans Medical and Surgical Journal.

as an excuse, that the Hebrew women were not as the Egyptian wo-
men, who were more lively, and were delivered before the midwives
could be with them. This curious statement is in the first chapter of
Exodus. It is necessary to remark that this may have been a pre-
text of the Hebrew midwives to save the male children of their peo-
ple ; and it might also be possible that the labor of the Egyptian wo-
men was somewhat more tedious than that of the others, although not
more dangerous. The Scripture history would induce us to incline to
the former opinion. The influence of climate on parturitiou is well
known to be very great. We are not aware that there was any
material difference betwen the climate of Palestine and that of
Egypt ; and both nations, the Hebrews and the Egyptians, were of
a common origin. They came from Chaldea, the centre of the subse-
quently far famed Assyrian empire. So far, we can find nothing be-
yond the fact of the existence of midwives.

The Greeks may be considered, according to the knowledge which
we possess, the pioneers in scientific male midwifery. In the time of
Hippocrates, who died about 373 B. C, this branch of medical sci-
ence was much cultivated, and the writings of that period evince as
much, if not more, research and practical experience, than can be found
in most part of Europe during the last century. Their system, how-
ever, was defective, and too much tinctured with superstition. Illithya
was, in their belief, the goddess who presided over the birth of chil-
dren, and they often contented themselves with invoking this imaginary
deity. We know that with the aid of nature, Faith can work mira-
cles.

About one hundred years before the Christian era, Soranus, said
to be a Roman, and Moschion, a Greek, drew up the first manual of
midwifery, which is to this day to be found in certain libraries. Their
knowledge was derived from the writings of the Hippocratic age. As
to scientific facts and principles, they added but little ; they however
collated faithfully and condensed ably the accumulated facts of their
predecessors.

The Romans, in the early period of their history, employed very
simple means to facilitate the delivery of pregnant females. Their
chief dependence was invoking, and sacrificing to Juno, Lucina, and
other imaginary deities. The prejudices existing in those remote pe-
riods of time against any violation of the human body, deprived the
medical faculty of that anatomical, physiological and pathological sci-
ence, which has made such progress in the last half century, and
which is so important in imparting efficient practical assistance, when

Dr. Hort's Report on Midwifery.

477

art is required to sustain and aid nature in a difficult case of parturi-
tion. At a later period, that which intervened between the downfall of
the so called Roman republic, and the despotic reign of the Caesars,
women were emplo)ed as midwives, and their services proved ade-
quate, with few exceptions, for the climate was mild, and the manners
uncorrupted. Under the Emperors, when morals were debauched
by licentiousness, and constitutions were undermined by luxury and
dissipation, the difficulties of parturition became greatly increased, and
women were found not to possess sufficient nerve to officiate in critical
cases. There is on record a singular debate on this subject in the
Roman Senate, the result of which was to prohibit women from act-
ing in dangerous cases, where art and great firmness were required,
and to assign the duty to men properly qualified, according to the know-
ledge of that age.

We now pass to the middle ages, as they are termed— a portion of
time intervening between the lives of Aristotle and Bacon. A most
dreary period in the drama of human life, when amidst great moral and
political convulsions successive empires arose, predominated, declined,
and fell — when to the world, the lights of science were extinguished
— when there was neither learning, nor justice, nor pity, nor remorse,
in the feudal castles — when the thick darkness of night oppressed and
bore down intellectual energy and moral worth amongst the masses —
when war was pastime, and robbery, and murder, and licentiousness
constituted fame and earthly glory. Whilst this wave of moral darkness,
superstition and crime was sweeping over Europe, the science of mid-
wifery, in common with all other sciences, was paralyzed, and retro-
graded. All that we know about the obstetric art during those disas-
trous ages is, that when the mother died before the delivery of the child,
the foetus was cut from the body. We presume that the allusion is to
the Caesarian operation, for the mother being dead, that would be deci-
dedly the best mode of procedure for the convenience of the practi-
tioner and the safety of the child.

From the 13th to the commencement of the 14th centuries, the Popes
lamentably retarded the progress of this art, and of medical science gen-
erally. New schools were established, but the professorships were
conferred upon monks, to whom was accorded the privilege of practising
medicine, while the study of anatomy and the practice of surgery were
prohibited to the laity, no matter how anxious the Physician might be to
acquire knowledge, or how great the intellect, skill and experience he
might possess.

478

The New-Orleans Medical and Surgical Journal.

As might be naturally supposed, the obstetric art became, under such
circumstances, more than ever governed by superstitious ignorance, than
by the lights of science. When the skill of the monks, aided by women,
and ignorant persons amongst the peasantry — (their submissive tools)
was completely baffled, they resorted to prayers to the Saints. Images
and holy relics were appended to the suffering woman in hard and pro-
tracted labor. No improvement took place until the sixteenth century.
The rule and domination of the priesthood were predominant and over-
whelming to truth, justice and science.

Early in the sixteenth century, the great improvement that had been
made in the art of printing and engraving, caused the reprinting and
multiplying, and diffusing of such works of the Greeks, Romans and
Arabians, as had been saved from the general wreck. A rapid change
in consequence took place ; a general spirit of enquiry was excited
amongst men of education. Intellectual intercourse between eminent
professors followed, and in such efforts and contests, truth could scarcely
fail to be elicited. The science of midwifery participated in the gene-
ral movement, and in the general progress. The practice, however,
was exclusively in the hands of women ; it was deemed disgraceful for
a man to be engaged in it ; and it was considered, when practised by
a man, to be a grievous attempt on the virtue and honor of the female
sex. In Hamburg, for this offense, a man named Veites was con-
demned as a magician, and centenced to the flames. Several works
for the better instruction of midwives were published. In 1513, Eu-
charius Roslein, a citizen of Worms, published a work called the Rose-
Garden, for Midwives and pregnant women. The greater attention
at that time paid to the science of anatomy tended much to the improve-
ment of midwifery. Vesalius distinguished himself in this branch of
medical science in the city of Padua, in Italy, in 1543. Whilst the
physicians and surgeons were attending to the theoretical part of the
science, Vesalius devoted himself to the practice. He operated upon
the body of a woman who had died without giving birth to her child,
by the Caesarian mode, which operation is said to have been per-
formed on the mother of Julius Caesar to accomplish her delivery, and
from which circumstance the name of the operation is said to be deri-
ved. This proceeding had a century previous been prohibited by law,
which at this time commanded it. Vesalius gradually undertook the
management of women, both during pregnancy and when in labor. In
1581 Rousset, a surgeon in Paris, published a treatise on the subject
of the Caesarian operation, in which he affirmed the possibility of its
being safely performed on the living woman, and he even cited several

Dr. Hort's Report on Midwifery.

479

cases which in his practice had been attended with success. We are
informed that Rousset first gave the name of Ccesarian to this opera-
tion. After the publication of this treatise, the operation was fre-
quently resorted to in France and other parts of Europe ; and even in
some cases where it was not absolutely necessary.

Pineau, another Parisian surgeon, was the first to suggest the section
of the Pubes. This was in 1539. He had observed that in some in-
stances, where the narrowness of the pelvis made the delivery of the
child difficult and critical, a spontaneous separation of the bones took
place. This separation is not a natural proceeding. It is the result of
a desperate effort of nature to relieve herself in a case of extraordinary
difficulty. Some women may have been uninjured by this operation,
but we fear that by far the greatest number have been rendered suffer-
ers for life. If we aim to save the life of both mother and child, and
the only condition is the yielding of the bones, art is surer, although
we cannot say safer, than nature. The former can always effect the
object ; the latter may fail, as we well know is often the case.

In the 17th century, Midwifery did not make so much progress in
Germany as in France and Italy. In the first named country the mid-
wives were generally ignorant, and men were very rarely employed.
In the latter countries, however, Physicians and Surgeons were chiefly
employed in directing, in difficult cases, or personally assisting the par-
turient woman. It is well known to all the members of this convention,
that medical science advanced slowly, though surely, in all its branches
to the end of the 17th century. Towards its conclusion, Clement, ano-
ther Parisian surgeon, who was much distinguished in the practice of
midwifery, attended Louise La Valiere, the mistress of Louis XIV.,
which proved successful, although attended with some danger. For
his success on this occasion he received the name of Accoucheur, which
was given him as an honorary title.

The first surgeon in Holland who endeavored to establish midwifery
on scientific principles, was a practitioner named Henry, who resided
and practised midwifery in Deventer.

In 1745 a school for midwives was established in Paris. It was the
beginning of what is now the celebrated Hotel Dieu. From the time
of Hippocrates, instruments had been used to facilitate difficult cases of
labor. A general description of these instruments may be found in a
work published by Abacasis, and entitled Methodas Medendi. (Second
Book.) Also by Rhuet, at a later period, in a work entitled Be Con.
ceptione.

480 The New-Orleans Medical and Surgical Journal.

Between the years 1660 and 1667, a surgeon of London named
Chamberlen affirmed, that he had invented an instrument, with which
he was able to terminate the most difficult labors without any injury to
the mother or child. It does not appear that this invention was com-
municated by him to any member of the faculty in Great Britain, but
in 1688 he visited Amsterdam, and sold his secret to several practi-
tioners, who derived much benefit from it. This is probably the origin
of the improved modern forceps. In 1722 Palfyn, a distinguished ana-
tomist and surgeon of Ghent, in Flanders, having by some means
acquired a knowledge of the instrument, had one made for his own use.

Whatever discovery in relation to the forceps had been previously
made, Chamberlen generally has the credit of being the first to make
the blades of the forceps admit of separation, so that one part at a time
could be introduced into the vagina or uterus, and be carefully adjusted,
and when both blades were properly applied to the head of the child,
they could be locked together, improvements to this useful instru-
ment were subsequently made by Levret in Paris, Plevier of Amster-
dam, and Smellie in London. The principle was the same in all these
improvements ; there was simply some modification in the form and
shape of the instrument. Their writings and lectures on Midwifery
tended much to improve the art. About the same time considerable
progress was made in Germany by distinguished Physicians and Sur-
geons, through their writings, and by their public instruction. Schools
of Midwifery were established in the Universities, and with the aid of
the collateral branches of instruction, the art was brought nearly to the
perfection which it has at present attained. Germany may boast of
many eminent men, who excelled in this department, and who were
alike distinguished for their operative skill, sound judgment, and the
diffusion of correct principles. So far in the present century, the repu-
tation of the German Accoucheurs has been well sustained by the two
Starks of Jena, by Osiander of Gottingen, by Siebold of Wursburg,
and by Wegand, Nagele, Boer and J ury.

Amongst the celebrated English Accoucheurs, we have to speak of
Dr. William Hunter. His writings were voluminous, and in the high-
est repute. It is unnecessary to allude to the various subjects of
which he treated ; we shall therefore only speak of his works and
opinions that are connected with our subject- The most elaborate and
celebrated of his publications was the Anatomy of the Gravid Uterus,
illustrated by 34 large plates, and published in 1775. Three years af-
terwards he published reflections on the Section of the Symphysis Pu-

Dr. Hort's Re/port on Midwifery.

481

bis, in which he maintained the danger and impropriety of that surgi-
cal operation. Both he and his brother John had great confidence in
the powers of nature in parturition, viewing it as simply a natural ope-
ration ; and both were opposed to the use of instruments. Smellie,
White, Bland, Denman, Burns, Gooch, etc., were also distinguished for
their skill in the management of dangerous cases, and their instructive
writings and lectures.

We have already spoken of some French Accoucheurs of note; to them
may be added Ambrose Pare, Mauriceau, Guillemeau, Maubray, Le
Motte, Peu, Puzos, Maygrier, Baudelocque, Velpeau, Dubois, Chailly,
etc. Some of these are more distinguished by their writings, and
others by successful practice.

In the United States, Shippen, a pupil of the celebrated Wm. Hunter,
Dewees, Professor of Midwifery in the Medical Department of the Uni-
versity of Pennsylvania, and the author of perhaps the best treatise on
the subject published in this country, and Bard, President of the College
of Physicians and Surgeons in the University of the State of New York,
and who published an excellent text book for students on the Theory
and Practice of Midwifery, have well sustained the reputation of the
Medical Faculty in this branch of medical science, on this side of the
Atlantic.

SECOND PART.

Eminent practitioners have differed much about the propriety of using
instruments. Some have argued forcibly against the use of them, ex-
cept in certain critical cases, where nature appears to be inadequate
to the expulsion of the foetus. And others have been in the habit of
using them on almost all occasions. We have already seen that Mau-
bray, a French practitioner, and the two Hunters of London, were op-
posed to the use of instruments. Dr. Bard, in the introduction to his
work on Midwifery, thus observes — " I confess, not without some re-
gret, that towards the end of thirty years practice, I found much less oc-
casion for the use of instruments than I did in the beginning, and I be-
lieve that we may certainly conclude, that the person, who in propor-
tion to the extent of his practice, meets with most frequent occasion for
the use of instruments, knows least of the powers of nature ; and that
he who boasts of his skill and success in their application, is a very
dangerous man."

The opinion of the committee is, that they should never be employed
unless it may be the only possible means of saving life. When the
foetus is implicated in the upper strait of the Pelvis, either within reach

482 The New-Orleans Medical and Surgical Journal,

or out of the reach of instruments, it matters not which, all that is
necessary to relieve this condition of things, and to produce a favorable
presentation, is to relax as suddenly as possible the system of the suffer-
ing mother ; and we believe that bleeding from a large orifice, the wo-
man at the same time sitting Up in bed, will almost invariably bring
about' both results. The head being the heaviest part of the body
of the foetus, naturally descends and presents itself at the mouth of the
womb. As a general rule, the system may be considered sufficiently
relaxed when perspiration breaks out in large drops, and the woman
complains of a sick stomach. Hippocrates has given the sanction of
his authority to bleeding in lingering cases. We believe that a sudden
loss of blood by venesection is usually eminently useful at the commence-
ment of labor. It was recommended by Dewees and Francis, in their
lectures, and is approved of by the profession generally. On the other
hand, nothing is more injurious to the mother and the child than re-
peated bleedings, from the time that the woman becomes pregnant
until the period of parturition. Your committee have seen the lament-
able effects of such practice ; and when the habit becomes established,
the woman will be repeatedly bled in spite of the Physician. This
pernicious practice being persevered in for several years, almost inva-
riably terminates in a loss of vital energy, which renders life a burden,
and entails premature old age or death.

Before dismissing this part of the subject, we would advert to a cer-
tain condition of things, which formerly proved very embarrassing to
the practitioner, and endangered the life of both the mother and the
child. It is when the head of the child has taken a wrong direction,
and bears down on the rim of the pubis. In this case instruments are
unavailing, and the effect of bleeding uncertain. The only safe plan
is to watch an opportunity of introducing a finger between the head of
the child and the pubis of the mother, which serves as a most safe and
efficient lever to give the right direction to the head. This mode
of proceeding was pointed out by Professor Dewees more than thirty
years ago.

The use of belladonna in causing dilatation of the mouth of the
womb, as employed and recommended by Professor Cenas, will materi-
ally aid to bring about this result, either alone or in conjunction with
blood-letting. The use of this article was probably suggested by its
effect on the pupil of the eye, when applied previous to the operation
for cataract. It is well worth the attention of the faculty ; and the ex-
perience of numerous practitioners, after a sufficient trial of it, may

Dr. Host's Report on Midwifery. 483

lead to some important modification of treatment in Obstetrics.* In
diseases of the womb, where the speculum is used, belladonna can
hardly be dispensed with.

Ergot, orsecale cornutum, is another important remedy in a certain
condition of the parturient female, which should be noticed on this occa-
sion. It is a diseased condition of the well known plant " Rye," which
when thus vitiated, has been known to be for more than two centuries
productive of dangerous gangrenous diseases in Europe. The com-
mittee are not aware of what particular circumstance suggested its
use in lingering labors. It was first introduced into practice in France,
to excite the womb, which, when unassisted, was not adequate to the
expulsion of the foetus. In Chapman's Therapeutics, published about
thirty years ago, it is remarked, that in France " the practice seems
not to have been regulated with any propriety, and ceased after a short
time." He then observes, " As an article of the Materia Medica, the
credit of establishing it must be conceded to this country. It is fifteen
or twenty years since Dr. Stearns, of the State of New York, pub-
lished an account of its wonderful powers in accelerating lingering la-
bors."

Professor Chapman further remarks, that his experience "enables
him to speak positively of its powers in this respect." The committee
entertain no doubt of the powerful action of the secale cornutum in
stimulating the exhausted womb to renewed efforts to expel the foetus ;
yet it is, in the hands of inexperienced and incautious practitioners, a
most dangerous remedy. Should it be administered before the os tin-
cae and the vagina are sufficiently dilated, rupture of the uterus, followed
by the death of both the mother and the child, would be the probable
consequences.

It follows, then, that the attending Physician should be satisfied that
there is a well formed pelvis, and a natural presentation, as well as
ample dilatation of the soft parts, before the remedy in question can
be used with safety. Dr. Francis, Professor of Midwifery in the city
of New York, having prescribed this remedy for a number of years,
was of opinion in 1822 that it had a decided tendency, when frequently
taken by the same individual, to prevent her subsequent impregnation*
The committee are not able to confirm or refute this opinion.

As the necessity for employing ergot depends solely on atony of the

* It may render altogether unnecessary the disagreeable, painful and dan-
gerous practice of endeavoring to dilate the orifice of the womb by mechanical
force.

484 The New-Orleans Medical and Surgical Journal.

uterus, and not upon any structural defect, or the want of dilatation of
the soft parts, it is probable that it would be seldom required in the
course of one Physician's practice. Yet from its known poisonous
qualities, there is reason to believe that however beneficial its action
might prove on one occasion, it would, if frequently administered to the
same person, disturb the vital functions of the system, and even be pro-
ductive of the consequence suggested by Professor Francis, It is pro-
per however to state, that Professors Chapman, James and Dewees, of
Philadelphia, who between them administered ergot in more than two
hundred cases, never saw it produce any ill effect on the child. Doctor
Chapman further affirms, that he never saw harm produced by it in
any respect, and that reports from other places confirm this opinion.
[Concluded in our next.]

VII.— BIOGRAPHICAL SKETCH OF THE LATE VOLNEY MET-
CALF, M. D.5 NATCHEZ, MISS.

BY C. S. MAGOUN, M. D., MISS.

Already has too much valuable medical history been lost to the
world and the medical profession in this South- Western section of the
Union. Many brilliant and useful members of the profession have fal-
len in the midst of a career of toils and hardships — standing firm and
undaunted at the post of danger — combatting the fearful diseases " that
stand thick around, to hurry mortals to the tomb," and no historic re-
cord has preserved their names, their services, or the impress of
their lives from the tomb of oblivion. It is time this state of
things should exist no longer ; henceforth let the historic page of me-
dicine do its duty to the lives and services of ihe departed, as they in
life did their duty to the suffering sons of want, in the extremity of dis-
ease and death. When such men as the subject of this memoir are
stricken down, having adorned their age and profession, it is right that
we should profit by their example, record their many virtues, and our
knowledge of their labors, and thus transmit them to those who are
soon to come after us, and fill our places in the active duties of profes-
sional life.

It is a consoling reflection to a good man, in his last moments of
existence, to know and realize that all his efforts have been directed
in one undeviating course to the accomplishment of the greatest good
to the greatest number. The humane and benevolent Physician, who

Dr. Magoun's Sketch of the late Dr. Metcalf.

485

has labored during the active period of his life, in endeavoring to miti-
gate its ills and miseries, by administering to the rich and poor alike,
in the cold and stormy wintry blast, and amid the sultry and piercing
summer's sun, and the damps and chills of the midnight hour. He has
sleepless and disturbed nights of rest, irregularities of diet, uncomfort-
able accommodations, with the heavy cares and responsibilities of his
many patients pressing upon his mind, and rendering his excited feel-
ings still more severe. He has high and exalted claims on the com-
munity for their gratitude, when his life and his labors have been
spent, and he should be held in lasting and grateful remembrance.
Physicians may, and often do, regret their inability to afford the desired
relief to their suffering patients, from the imperfections of the art of
medicine; but still, if efforts are well directed, and failure attends, from
uncontrollable disease, they should receive no less esteem than when
they have the pleasing recollection of being instrumental in accom-
plishing the end desired.

Dr, Metcalf was the youngest of five sons of John Metcalf of Fau-
quier county, Virginia, but was born in Flemming county, Kentucky, on
the 19th of September, 1804. His death took place after a few days'
illness, at his plantation on Tensas river, in the parish of Concordia,
on the 19th of October, 1852. He was called from Natchez to visit a
physician in the neighborhood of his plantation, but was taken sick
while on his way, and was unable to return home. His family were
sent for, and arrived in time to administer to him in his last moments.
He leaves a wife and several children to mourn his loss. Few men
ever shared more largely in the esteem and confidence of all ranks
and classes of society. His death has been a public calamity. His
practice was extensive, constant and laborious ; aud many times has the
expression fallen from the lips of his former patients — our beloved phy-
sician is gone !

, ^He received his preparatory and collegiate education from the Profes-
sors of Yale College, where he graduated with distinction, enjoying the
esteem and confidence of its professors. He then repaired to Phila-
delphia and commenced the study of medicine under the tuition of the
distinguished Dr. S. Jackson. He attended the lectures and graduated
in the University of Pennsylvania, and then removed to Adams county,
Mississippi, the residence of his brother, Dr. James Metcalf, who was
older than himself, and engaged at that time in an extensive and lucra-
tive practice, with whom he commenced business, and remained en-
gaged in the active duties of his profession for two years. But becom-
ing dissatisfied with his medical attainments, and ambitious to improve

486 The New-Orleans Medical and Surgical Journal.

and distinguish himself, he repaired to Europe, spending most of his
time in Paris, devoting himself to hospital practice, and in attendance
on the lectures of the distinguished Professors of that great school of
medicine. After an absence of about two years, he returned to the
United States, and located in Natchez in 1838* Of the manner in
which he spent his time in Paris, I shall make use of the language of
one of his medical cotemporaries, who was with him a whole season
in that metropolis.* " I found him regular in his attendance at the
hospitals, and a close observer of the various diseases met with there .
in. He cared but little for gay company, and the frivolities of that capi-
tal, which were constantly] passing before him, without turning from
the even tenor of his way. Quiet, cool, yet cheerful — observant, and
temperate in all things — he made the best possible use of his time, as a
student, and set an example worthy of imitation. What he pretended
to study, he studied deeply and thoroughly, and I am indebted to him
for much useful information on many points connected with practical
medicine. Among others, I may mention that of wounds of the head,
and concussions of the brain. He told me that the best time to make
observations on such affections was by candle-light, on Sunday morn-
ings. He said the poor laborers of Paris, on returning home on Satur-
day night with their week's wages, were often knocked down and rob-
bed, notwithstanding the numerous guards of the city. They would
be removed to the hospitals early Sunday mornings, or during the night,
with their wounds fresh and often bleeding, requiring immediate surgi-
cal attention. It was only the early risers, among the students, who
would get an opportunity of seeing the wounds dressed, or witness the
practice of the French physicians in concussions of the brain. He
was a man, when abroad, not to be ashamed of his country, but was
ever ready, on the proper occasion, to vindicate its customs and insti-
tutions from the sneers of the ignorant and conceited."

Unlike many medical men, Dr. Metcalf returned to his native land
imbued with the early principles and doctrines of his medical educa-
tion. The full and efficient practice among the poor, destitute and
half starved population of Paris, was not adopted by him for the well
fed and robust among our laboring classes. Great discrimination was
necessary, in making the proper distinction between the treatment ap-
plicable to the two countries. This discrimination he possessed in a
remarkable degree. He was not turned aside by the specious and fal-
lacious reasoning of the eminent lecturers abroad from the true course
indicated by careful study and laborious research. His European tour

* S. A. Cartwright. M. D.

Dr. Magoun's Sketch of the late Dr. Metcalf. 487

improved him much, and to a very considerable extent aided in laying
the foundation of his future brilliant career.

On his return from Europe he selected this city as the field of his
labors, in 1838. In the autumn of the following year he was laid pros-
trate by an attack of inflammation of the knee, which resulted in a
dropsical effusion of the joint. He was thus compelled for a time to
quit his practice, and retired to the mansion of his brother on Second
Creek, in this county.

After some months confinement, he was enabled to resume his prac-
tice, which he did in connection with his elder brother, who shortly
after retired from the practice. In this location he remained till 1850,
when he settled in Natchez, having acquired an enviable name, and an
extensive and lucrative practice. On re-establishing himself in this
city, he was extensively known and duly appreciated. He at once
gained a desirable practice, was often called in consultation, and per-
haps there has never been a physician here who made more consulta-
tion visits, and was more esteemed by his confreres. His urbane,
frank and conciliatory manners inspired the good will and respect of all
in association with him. His high sense of honor and fair dealing
was known to all his medical brethren, so that he could be trusted to
any extent in all the emergencies of professional life.

In the language of another, " he was in practice energetic, but not
rash, accurate and discriminating in his diagnosis, a perfect adept in
physical exploration — devoted unusual time and attention to the physi-
cal signs of disease, which gave him great advantages over the common
run of physicians." He was among the first to use the sulphate of
quinine in large doses ; he contributed largely to establish this practice,
which has of late years become so common and of so much value.
Possessing a retentive memory, he kept pace with the advances in
pharmaceutical preparations, and thus had all the improved remedies
at his instant command. His resources were ample in all difficult and
trying cases — laying aside the authority of books and taking a common
sense view of the case, he more than met the expectations of his friends,
in his success. His example will long survive. He has gone to his
reward — in the midst of his career of usefulness — a victim to the dis-
ease which he often encountered — yellow fever. Let his virtues be an
incentive to the living.

Natchez, Nov. 18, 1852.

488

The New-Orleans Medical and Surgical Journal.

VIII. — REPORT OF THE CHOLERA AT SACRAMENTO IN 1852—

lis Analogy if not identity with Malignant Congestive Intermittent — the attendant
meteorological 'phenomena — history, palhology and treatment of the disease. In
a letter to the Editor.

BY THOS. M. LOGAN, M. D., OF SACRAMENTO, CALIFORNIA.

The most propitious season for studying the Cholera in some of its
peculiar relations and analogies, is just passing away, and I hasten with
scientific avidity to reduce to paper the fresh impressions derived from
renewed experience and trial.

Faithful to the promise expressed in my last communication, to ob-
serve the effect of the submersion of our country upon the general
health, I called in the aid of meteorology, and to it assigned the office of
sentinel on the watchtower of disease. By the 1st of August the ave-
rage thermometrical range at 3 o'clock, P. M., having reached above
80 ° , I became warned by the bearing of this fact in vital statistics to
expect the approach of the insidious foe that "walketh in darkness and
destroyeth at noon day." Still my apprehensions were in a manner
quieted, when I reflected upon the medium hygrometric state of the
atmosphere, which was sustained by the continued prevalence of south-
erly winds, charged with oceanic vapor.* About the middle of August,
however, these life giving breezes began to fail, and a northerly wind
by night, the Simoon of this region, poured in the noxious emanations
of a vast extent of Tubare or swamp land, as well as the desicated air
of hundreds of miles of arid desolation.

Soon the reports of occurrence of cases of Asiatic Cholera were pro-
mulgated by several respectable Physicians, and the mortality of the
city became insensibly increased. Knowing the powerful influence of
a panic in spreading the ravages of such an appalling disease as the so
called Cholera, I unscrupulously raised my voice in denying its exist-
ence, except in a modified state, and which I conscientiously could do,
entertaining the peculiar views I have already published in your valua-
ble Journal respecting the Cholera of 1850 in Sacramento. These
views have now received " confirmation strong; " at least strong enough

* Since writing the above I am credibly informed that the South winds,
which "bears healing on its wings" to us, is the very wind which carries pes-
tilence and death to Colusa, Shasta, and all the northern country. This offers
the best evidence of the correctness of my observations, inasmuch as the South
wind, after reaching the locality of Sacramento, passes in its course over the
same region, and necessarily carries along with it the same deleterious atmos-
phere that the northerly winds do in visiting our city.

Dr. Logan on the Cholera at Sacramento in 1852. 489

to satisfy my mind. I do not claim originality in regard to them ; they
have been already advanced by the most able writers in our profession.
All I aim to do is to add my experience on a subject of the deepest inter-
est, and thus by enlarging the sphere of our observations, contribute to
the greater accuracy and profundity of future deductions.

Twenty years ago I entered the field of experimental practice with
the Cholera in Paris. It was in the spring of 1832, and the weather
was transparently clear and beautiful. Next I engaged in prolessional
conflict with it in 183G, among the rice swamps of the Waccamaw, in
South Carolina, during the autumnal fogs of that humid, unwholesome
region. Afterwards, in the winter of 1848-9, 1 encountered the same
disease in New Orleans, when and where it rained almost every day.
Finally, I have witnessed its development on the shores of the Pacific
during the arid and rainless autumns of California in 1850-52: and
thus having invariably found it to prevail irrespective of seasons, I think
my testimony is entitled to some weight, when I add my belief, that a
high thermometric range is not an essential, per se, in its develop-
ment.

Since the application of meteorology to medical science, it has been
discovered that if variations of temperature alone are not sufficient to
account for all the different diseases prevailing in certain seasons and
climates, the greatest value, nevertheless, is to be attached to the hy-
grometric condition. This latter, it would seem, though not technically
so, is the one really varying constituent of the atmosphere, often inde-
pendent, according to Espy, of rain and temperature, and is sufficient
to account for most of the influences ascribed to miasma. Thus the
Sirocco and Simoon, so named from the pestilences they have borne
upon their wings, have been found to derive their qualities mainly from
being charged with a plus or minus proportion of vapor. In the first
instance, the atmosphere becoming saturated with moisture, the decar-
bonizing power of oxygen on the blood is prevented, and the freedom
of the secretions so much increased, that the system becomes relaxed
and the blood impoverished ; while, in the second instance, so profuse
an evaporation from the blood, if I may so speak, is created, that vital
action is interrupted in consequence of the system being deprived of
the fluids requisite to sustain the organs in the due performance of
their functions. Either excess appears to be equally injurious ; and
this is proved by the fact that the sickliest countries and seasons inva-
riably have the highest dew point, and that in elevated or other regions,
or at sea, where the greatest salubrity is enjoyed, a medium hygrome-
tric state is usually present.

490 The New-Orleans Medical and Surgical Journal.

Now, these well established facts are in perfect accordance with all
my observations during the Cholera epidemics, and in no instance is
the coincidence of the irruption of the disease, with great hygrometric
changes, more clearly shown than in its late development in the valley
of the Sacramento. Indeed I candidly confess, that 1 did not perceive
until I came to California, and my attention was forced to the subject,
by the peculiar character of the climate, that either extremes of hy-
grometry had in every instance been attendant upon the appearance of
the Cholera ; and being heretofore at a loss to account for the preva-
lence of the disease at every season, and under seemingly every condi-
tion of atmosphere, I fell into the unphilosophical routine habit of attri-
buting its propagation to some inscrutable virus or principle of conta-
gion or infection. After, however, a due consideration of the events
of former years — of the actual circumstances just transpired, and the
morbid phenomena which presented — of the analogy with what occurs
in other countries similarly situated, with respect to geographical and
topographical position, as well as climatural influences, particularly
Louisiana — after a careful comparison of similar phenomena in certain
regions of the Eastern continent — in Persia, as observed by her Ma-
jesty's Physician to the Embassy, Dr. W. C. Bell — in India, by Mr.
Thorn, Surgeon to her Majesty's 86th regiment — in Poland, by Mr.
Searle — in Italy, among the Pontine Marshes, and elsewhere, as ob-
served by M. Bailly of Blois — the inevitable conclusion results, that
the malady which has just ceased its ravages, and which has prevailed
previously under the name of Cholera, not only here, but in Mexico
and Central America, originated, like any other endemic, independently
of any extraneous causes, and is essentially nothing more than a per-
nicious or congestive fever, of an intermittent type, which rapidly as-
sumes the most malignant symptoms, sometimes on the first day of its
invasion. Nor do 1 think it will be advancing in the premises too far
beyond the legitimate inference of analogical reasoning to assert that
Cholera, whether it prevails in India or California, in Europe or in
Africa, is every where and always one and the same disease, modified
by geographical influences and atmospherical vicissitudes.

If the qualities of the medium in which we breathe and live is ack-
nowledged to be capable of producing disease at all, under conditions
to which we are not accustomed, then why should not one form of dis-
ease be as well produced here as another ? We have the same meteo-
rological influences to contend with as one found to prevail in other
countries where Cholera is credited to originate, and more than this,
our systems are liable to the acquisition of exalted susceptibilities from

Dr. Logan on the Cholera at Sacramento in 1852. 491

a high range of temperature. That such a modification of disease,
then, as has just been witnessed, should be developed here, is not more
surprising than that Plague should exist in one country and Yellow
Fever in another ; or that Goitre is indigenous to Alpine regions and
dry gangrene to Mexico. Nor does it detract from the reliability of
my conclusions if the nature and modus operandi of the predisposing
and exciting causes cannot as yet be satisfactorily demonstrated. Doubt-
less as meteorological science becomes more cultivated, and successive
data are recorded, with which comparisons may be instituted, that
which appears obscure now may be made perfectly intelligible. The
spirit of philosophic research is abroad, and the search after truth will
assuredly penetrate the arcana of disease.

Let the result be as it may, however, the fact cannot be controverted
that a peculiar disease, call it modified Cholera if you please, has just
run its course here ; the same form of disease which prevailed in the
fall of 1850, and which I believe has existed in the country from time
immemorial.

Before proceeding to treat specially of the history of the disease in
connection with its recent irruption here, it becomes necessary to give
a glance at the geographical position and topography of the valley, in
the midst of which the city of Sacramento is situated, in order to sub-
stantiate my assertion; and after this I must leave to time and future
generations the evolution of the corrolaries that may confirm my as-
sertions.

This valley, together with that of the San Joaquin, may be consid-
ered one ; a single geographical formation, according to Fremont, near
500 miles long, varying in breadth from 40 to 80 miles, and lying at
the western base of the Sierra Madre, and between it and the coast
range of mountains, and stretching across the head of the bay of San
Francisco, with which a delta of 25 miles connects it. The two rivers,
Sacramento and San Joaquin, rise at opposite ends of this long valley,
receive numerous streams, many of them bold rivers, from the Sierra
Nevada, become themselves navigable rivers, flow towards each other,
meet half way, and enter the bay of San Francisco together, the region
of tide water, making a continuous water line from one end to the other.
The northern section of the valley through which the Sacramento
flows is upwards of 200 miles long, and is bounded on each side by ex-
tensive flats or Tulare lands, subject to annual overflow. These im-
mense tracts of marsh land are intersected in all directions by exten-
sive sloughs and lakes, which frequently have no communication with
either the Sacramento or its tributaries, except at the tmie of high wa-

492 The New-Orleans Medical and Surgical Journal,

ter, (for the Sacramento is considerably affected by the ebb and flow
of the ocean) or of freshets. In fact, the immediate banks of the Sa-
cramento, like those of the Mississippi, form, generally speaking, the
highest part of the country ; so that when the waters fall, a vast extent
of this submerged land remains undrained, and its stagnant waters are
left to be gradually dried up by evaporation. The whole valley lies
parallel with the Pacific coast, which runs from southeast to northwest,
and at the point where the city of Sacramento is situated, there inter-
venes a very small portion of this marsh land in a directly south line
between it and the ocean.

In a former letter, giving an account of the Cholera in 1850, I have
already adduced the history of the past, to show that the disease is nei-
ther new upon the shores of the Pacific, nor in California. As far back
as 1583, Cortes stated, that on his reaching the Pacific, so great a mor-
tality spread among his companions, that he was compelled to fly in
haste and abandon the inhospitable coast. The annals of the early
missionaries also show upon their pages that every autumn many per-
sons fell victims to a disease closely resembling Cholera. In corrobo-
ration of these historical facts, all the old Californians and early set-
tlers agree in testifying to the prevalence of a fatal disease here during
the fall ; and immediately after the conquest of the country, so terrible
was the malady at Fort Sutter, that nearly the whole garrison was car-
ried off. Thus it appears that long before Cholera was heard of, a dis-
ease existed in this quarter of the globe equally as alarming, and if it
was not equally as prevalent, it was because of the sparcity of the in-
habitants.

As to the special history of the disease this season, I would remark
that the same affections observed in 1850, and which generally precede
and accompany the appearance of Cholera in any city or country, pre-
vailed also to a considerable extent. Early in June diarrhsea and dys-
entery began to appear, intercurrent with occasional cases of remittent
and intermittent fevers. By the 1st of August the two last named dis-
eases became more frequent and unmanageable, generally assuming ty-
phoid symptoms. As the season advanced all these diseases seemed to
run into and modify each other, becoming more and more complicated
and grave. Finally a peculiar combination of morbid actions, marked
by features of periodicity, and embracing more or less all the symptoms
of the foregoing diseases, to which was superadded intense disturbance
of the -nervous system, declared itself.

About this time the hottest weather was experienced. There was
little or no circulation in the air, and when there was force enough in

Dr. Logan on the Cholera at Sacramento in 1852. 493

the wind to produce a perceptible current, it was generally from the
west or northwest. The atmosphere became insufferably parched and
heated, especially towards evening, after the action of the day's scorch-
ing sun. Vegetation dried up, and the whole animal kingdom seemed
depressed and exhausted under the prostrating influences. The mean
quantity of humidity contained in the atmosphere at this time was never
more than 35 to 40 per cent of that required for its saturation. Through
this series of morbid actions and concomitant meteorological phenom-
ena, so like what have been observed at Strasburg, and several other
similarly situated regions where Cholera has prevailed, I was led by a
species of natural analogies and easy transitions to suspect the nature
of the subsequent affection.

This form of disease began to unmask itself and show its true fea-
tures towards the last of August. At this period nearly every one in the
city was brought more or less under its influence. There were but
comparatively few inhabitants who did not complain, either at one time
or another, of an obscure pain at the praecordia, and oppression of the
heart, with coldness of the tongue and extremities, or some derange-
ment of the digestive organs with diarrhoea ; and this I regarded as
the forming or first stage of the affection. In those whose powers of
resistance to disease were feeble, or if the oppression was greater than
the power of the heart could overcome, gasping with a sense of suffo-
cation from a weight or lump at the epigastrium, were superinduced ;
the skin became pale, and the features shrunk, in consequence of the
blood deserting the superficial capillaries, and these symptoms were
generally accompanied or followed with the well known spasmodic rice-
water vomiting or purging. There were some varieties in these evacu-
ations, being sometimes more copious and violent than at other times ;
but, however else they differed as to their sensible qualities, this cir-
cumstance was universal, that they were devoid of fecal smell and con-
tained no bile.

The circulation soon became sensibly disturbed and lowered ; the
pulse could scarcely be felt at the wrist, while the temperature of the
body rapidly decreased. Now this cannot be regarded as a prolonga-
tion of the forming or cold stage, because, although the skin was icy
cold, the patient did not complain of coldness at all, nor act like a man
does when exposed to intense cold and subdued by it. On the contrary
all his desires were for cold drink ; he would throw off the covering and
desire to be fanned or refreshed with cold air. That these symptoms
were the result of an active condition of the capillary circulation, was
denoted by the pulse remaining contracted, small and wiry, as long as

494 The New-Orleans Medical and Surgical Journal.

it could be felt, and never becoming soft, slower or feebler, as in adyna-
mic collapse. Sometimes, nevertheless, the vomiting and purging
soon ceased ; and sometimes there was neither sickness nor diarrhoea
at all, but owing to unequal distribution of blood in the capillaries, ac-
tive congestions of either the brain or lungs manifested themselves :
in the first instance by total unconsciousness and stertorous inspiration,
with yet a full, strong, regular pulse ; and in the second instance, by
lividity of the countenance and blackness of the lips, with dyspnoea —
the skin in both cases being bathed with a cold sweat. Associated
for the most part with the symptoms of the second stage, there was
more or less spasmodic contraction of the muscles of the calves of the
leg, feet, hands, and sometimes of the abdomen. These spasms were
attended with some pain, and constituted the greater part of the pa-
tient's suffering. In every phasis of the disease, the renal secretion
was entirely suppressed. If, which was very rarely the case in sub-
jects judiciously treated, no amelioration of these distressing symptoms
occurred before twenty-four hours, a striking alteration took place in
the appearance of the patient. All facial expression was lost. The
eyes became hollow, glassy, and surrounded by a bluish circle ; the
pulse imperceptible at the wrist, and the tongue of a leaden color and
unpleasantly cold to the touch. The fingers became blue, shrivelled,
and corrugated like a washerwoman's ; the voice husky and faint ; in
short, the whole countenance as withered and ghastly as that of a
corpse.

Such were the symptoms which the term collapse might now be used
with some propriety to denote, for they always attended a fatal termina-
tion, which generally occurred in such cases without a struggle, or pre-
ceded only by a few short convulsive heavings of the chest. Occa-
sionally, after a short interval of repose, answering to a remission, a
slight appearance of reaction, indicated by some throbbing of the caro-
tids and warmth of the chest, was perceptible, attended with sleep,
from which the unhappy victim could be roused only for a moment.
Perfect coma succeeded, and the patient did not survive more than a
few hours. Generally, however, if not improperly treated, a decided
interval of repose, which I would call intermission, obtained in the
course of twenty-four hours from the commencement of the attack. This
stage was more or less imperfect in proportion to the perturbation of
the nervous system, caused by the state of congestion of the irritated
organs, and was indicated by a cessation of the spasms, vomiting, pur-
ging and cerebral disturbance. The breathing became unembarrassed
and a genial warmth diffusing itself gradually and equally over the

Dr» Logan on the Cholera at Sacramento in 1852. 495

surface, the patient would sometimes fall into a short but tranquil sleep,
accompanied with gentle perspiration. After an hour or so, he would
rouse up, and saying he felt better, might throw an unobservant Physi-
cian off his guard. The penetrant eye of experience would see, how-
ever, in the dull injected sclerotica, the torpor or stupor of all the facul-
ties, the now dry, red, and glistening tongue, enough to excite the most
active vigilance and most decisive treatment. It is the period of inter-
mission, and it is soon over. The irritation is persistent and is in the
abdominal nervous system ; and it is this continued irritation in this
region, which, transmitted to the brain, slowly, it is true, because cir-
cuitously, and through the plexus and ganglions of the grand sympa-
thetic, finally produces a coma, which terminates in death.

Such is the brief history, pathology and symptoms of the disease,
which prevailed here from the latter part of August until a correspond,
ing period in September, when, after a succession of cool, southerly
winds, it disappeared as abruptly as its advent was sudden and ap-
palling.

During all this interval we experienced the warmest and most op-
pressive weather, suddenly interrupted at times by a cool, chilling west
or northwest wind. For the greater part of the time there was no wind
at all, and although what little there was predominated from the south,
still this was not sufficient to rectify the defective hygrometric condi-
tion of the atmosphere already mentioned. As the sun sank in the
west, a complete atmospherical stagnation would set in until towards
midnight, when a cool northerly breeze would chill and thus excite to
disease the wearied and exhausted system. The almost universal op-
position manifested among the medical men of the city to the peculiar
views of the epidemic promulgated by my associate, Dr. J. F. Morse,
and myself, induces me herewith to subjoin our weekly meteorological
reports during this period, together with the accompanying remarks
published by us, in order to show how we were by gradation to suspect
the true nature of the malady, and its relations with Cholera. I would
remark, that the building in which our observations were made is of
brick, facing the south, with a free circulation of air through it, and
that the thermometer and barometer stood in the centre of the lower
story.

496 The New-Orleans Medical and Surgical Journal.

Meteorological Tables from the 29th August to 25th September.

1852. || Sunrise. || 3 o'clock p. m. || Sunset.

S-H

■4-3

% a

met

enh

met

enh

met

enh

^ a.

2
3

<! 02

SSE.

27.10

SE.

27.10

SE.

27.10

27. 9i

SE.

27. 9£

27.10

NW.

27.10

NW.

27.10

sw.

27.10

SE.

27.10

sw.

27.10

SE.

27.10

Remarks. During the past week there have been very unusual atmospheric
changes, as will be perceived by a careful examination of our table. By comparing
the 30th of August with the 3d of September, it will be seen that there is a difference
of fifteen degrees in the maximum heat of these two days. On the 2d September
the horizon was almost constantly beclouded, and in the evening of that day there
was a little rain and a good deal of vivid lightning in the southwest. On the evening
of the 3d, which was by two degrees the warmest day of the season, there was also
considerable lightning visible in the east. To these climatic changes, miasmatic ex-
halations and exaggerated rumors of the daily mortality may be attributed a marked
change in the prevailing diseases of the week. All of the maladies previously re-
ported have assumed a general congestive tendency ; a tendency which has in some
cases been so great, as to terminate the disease by many of the prominent symptoms
of Asiatic Cholera, during the first two or three days of its manifestation. That we
have had among us true Asiatic Cholera, is a matter about which there is abundant
room for doubt ; or if it is to be admitted, the disease is at any rate so modified as to
relieve it of its most appalling features. We believe that the disease which has in-
creased the mortality of the city is essentially a modified congestive ague, periodic
in its nature, and generally most amenable to a judicious application of remedies.
Indeed for the last two or three days there has been such a mitigation in the symp-
toms characterizing this form of the malady, that no important difficulty is experien-
ced in overcoming it. The disease is seldom complicated and unmanageable unless
it has been primarily neglected, or aggravated by the stimulating specifics which are
too commonly resorted to by invalids.

Dr. Logan on the Cholera at Sacramento in 1852. 497

1852. || Sunrise. || 3 o'clock p. m. || Sunset.

Sh"

"33

£i

Septem

Baro

Fahr

j£

| Baro

Fahr

Baro:

Fahr

SE.

27.10

SE.

27.11

27.10

27.11

sw.

27.10

27.11

27.10

sw-

27.10

sw.

27.10

NW.

27.11

sw.

27.10

sw.

27.10

27.11

sw.

27.11

sw.

27.10*

27.10

Remarks. The hottest weather of the season has been experienced during the
week, the thermometer having risen higher by two degrees on Friday last than on
any previous day. Contrary to what might have been expected, the mortality of the
city has sensibly decreased ; and when we take into consideration the vast number
of sick and valetudinarians now in the city, it is wonderful that the proportionate mor-
tality is so small. It is gratifying to find the opinion advanced by us last week thus
sustained, viz., that the prevalent disease " is most amenable to a judicious applica-
tion of remedies ;" and we trust before long to have the happiness of pronouncing our
city as free from disease as can reasonably be expected during the autumnal season
in an alluvial region subjected to annual submersion.

Sunrise.

3 o'clock, p. m.

Sunset.

NW.

27.10

27.11

27.11*

27.10

27.10*

27.11

78
68
62
64
64
66
62

w.
w.

NW.
NW.

27.10
27.10
27.10
27.10
27.10
27.11
27.11

89
81
75

83
86
88
82

sw.
sw.

NW.
W.

2710

27.11*

27 10

27.10

27.11|

27.11

Remarks. The weather during the past week, especially during the earlier part,
has been cool and agreeable ; but owing to the prevalence of a northwest wind, the
Simoon of our locality, for the last two days, there has been rather an increase of
sickness among us. We are happy to perceive, however, by Mr. Youman's report,
that the proportionate mortality continues to decline ; and this gives us reason to hope
that as soon as the present impure stagnation of the air is removed by a return of
our refreshing southerly breezes, a more improved sanitary condition will obtain.

496 The New-Orleans Medical and Surgical Journal*

1852.

Sunrise.

3 o'clock,

P. M. |

Sunset.

September.

Wind,

Barometer,

Fahrenheit.

Wind,

Barometer.

Fahrenheit,

Barometer.

Fahrenheit,

20
21
22
23
24
25

SE.
S.
SE.
SW.

NW.

28.

27.10

27. 9

27.11*

27.11

68
66
64
59
56
56
59

SE.
S.
SW.
NW.
NW.

28.

27.11.

27.10

27. 9

27.11

27.11*

82
74
72
68
67
70
72

s.
s.

SE.
S.

SW.
SW.

28.

27.11

27. 9

27 9

27.11

27.11*

78
70
67
65
86
70
72

Remarks. A succession of cool southerly winds since the beginning of the past
week, has supplied the necessary moisture for a healthy hygrometric condition of the
atmosphere. In addition to this propitious change, we have to record the occurrence
of a frost in the neighborhood of our city. As might have been expected from the
well established laws of meteorological science, the sanitary condition of the whole
country has been influenced by these important changes ; and with the exception of
intermittent and typhoid fevers, and the sequelae of former maladies, we can pronounce
our city to be in a state of comparative immunity from disease.

The above reports and observations, which are copied verbatim from
our daily papers, constitute intrinsically the most reliable account of
the past epidemic, inasmuch as they were drawn up from time to time,
in accordance with the stringency of facts, and the impressions made
upon us at the moment. They were intended to subserve no special
purpose, further than to furnish the public with a true statement of the
actual sanitary condition of the city, and thus to prevent, as I have be-
fore stated, a panic — the most fruitful agent in propagating an epidemic.
That this object was accomplished, the following abstract from the mor-
tuary reports incontestibly prove.

Deaths in Sacramento for four weeks beginning 29th August, and end-
ing 2bth September, 1852.

CHOLERA.

OTHER DISEASES.

TOTAL.

First week,

Second "

Third <•

Fourth "

147

Dr. Logan on the Cholera at Sacramento in 1852.

499

Thus it appears that the aggregate number of deaths by Cholera dur*
ing the four weeks of the greatest prevalence of the disease amounted
to only eighty-eight ! Was such a result ever heard of before in any
country where Cholera ever prevailed ? And when, too, it is stated,
that the population of the city amounted to at least ten thousand, and
that of these about two-thirds suffered more or less from the epidemic,
the marvel will become still more marvellous. If I am in any possible
manner amenable to the charge of an infringement of medical ethics
in publicly contradicting the whole medical faculty of the city, by stat-
ing that no Cholera existed, because with my preconceived views I re-
garded Cholera as a species of congestive intermittent, I nevertheless
rejoice that I had the moral courage to hazard what little medical repu-
tation I may possess in staying the ravages of so appalling a disease
as Asiatic Cholera, which every Physician, with one exception, pro-
nounced it.

After this candid statement of the naked facts connected with the
appearance and progress of the disease called Cholera in Sacramento,
I deem it would be supererogatory in me to adduce any further arguments
to sustain my premises. The ingenuous mind must acknowledge that
if the history and pathology of the disease which I have endeavored
succinctly to describe, be sufficient to establish its identity with Cho-
lera, they are also equally cogent in proving its assimilation to the al-
gid form of the perncious intermittents, such as were so long ago ac-
curately described by Torti, Ramazzini and others, and in our times by
Rubini, Bailly and Maillot. In both diseases we find the same gastro-
intestinal symptoms, the same complete suspension of the natural secre-
tions, and in their stead the same inordinate discharges of serous fluid
from the blood, from which the patient falls into a deliquium as from
bleeding. How then is it possible to draw the line of diagnosis be-
tween them ? What two other diseases, excepting an occasional case
of yellow fever, ever exhibit the singular phenomenon of a patient be-
ing entirely pulseless, even up to the large arteries, and yet preserve
his intellect and powers of locomotion ? Or, contrasted with this well
known fact in the most commonly recognized stage or variety of these
two diseases, in what other series of morbid actions is such an altera-
tion of sensibility, thought and motion, as amounts to apoplexy, ever
met with, while the pulse remains full, strong and regular, and the skin
is bathed with a cold sweat ? We leave the solution of these difficul-
ties to the dilettanti in pathognomonics, and pass on to the treatment
which will, perhaps, develop my views of the disease better than what
I have already written.

500 The New- Orleans Medical and Surgical Journal.

It must not be supposed that all, or even a majority of the cases we
were called upon to manage, were distinguished by such formidable
features as have been already mentioned in my general summary of the
symptoms. During the prevalence of the epidemic, it was my fortune,
in company with my colleague, to treat an average of about fifty patients
per diem. That most of these presented very mild symptoms, or were
most successfully managed, will readily be accredited when I add, that
out of the whole number but five died, and these were either from
among those of the intemperate class, or those who neglected the pre-
monitory symptoms, and were in a moribund condition at the time we
were called.

It was our invariable practice, whenever a patient applied for advice
during the impending or forming stage, to impress upon him the abso-
lute necessity of abstaining from all kinds of excitement, intellectual or
bodily, sentimental or sensual ; to avoid the erect posture, whereby the
heart is quickened many contractions, as evinced in the differential
pulse, and to seek repose, or the recumbent posture, which natural in-
stinct would suggest. Next, in order to restore an equable tempera-
ture, we directed, according to circumstances, either a sinapism to the
epigastrium, or a hot sinapized pediluvium— generally both at once.
Believing the chief irritation at this time to exist in the series of or-
gans contained in the abdominal cavity, and which are governed chiefly
by the ganglionic system of nerves, we took special care, whenever
and wherever we could, that nothing should be administered which
might increase the irritation or complicate the disorder in this region,
unless diarrhoea presented ; and this we generally succeeded in con-
trolling, either with a few pills of blue mass and morphine, or the ordi-
nary chalk mixture, to which a small portion of Sydenham's laudanum
was added. If there was irritability of the stomach, we readily ap-
peased it with a few doses of the following mixture — the decoctum al-
bum of Sydenham modified.

# Calcis Phosphas 3 jj

Aq. Flos. Aurant. § ss
Sol. Gum. Acaciae f iiiss
Fiat Mix. Sig. Cock ; om. semi hora.

Thoroughly carried out with total abstinence from food of any kind,
this course generally proved efficacious in the majority of cases we
were called upon to treat in the incipient stage. When, however, after
the lapse of twenty-four hours, as not unfrequently happened, a recur-

Dr. Logan on the Cholera at Sacramento in 1852. 501

rence with aggravation of the primary symptoms occurred, (and a great
proportion of patients generally put off applying for advice until this
stage in the disease) other and more active measures were speedily
resorted to. Regarding the disease in the same light as Dr. W. C.
Bell, whose philosophic views and reasonings have guided us in every
step of the treatment, we believe that the ordinary action of the capil-
lary circulation is now strangely altered. The blood is poured in-
wards, and distending the cavae and oppressing the heart, which is heard
struggling and churning, in the active endeavor to overcome obstruction,
is necessarily driven back from the gorged vessels upon all the inter-
nal venous branches unprovided with valves. " The renal veins,"
quoting the same authority, " are next distended, and the returning cur-
rent of blood from the kidneys is stopped ; consequently, a first symp-
tom of such congestion is the cessation of the secretion. In like man-
ner the hepatic circulation is oppressed, obstructing the secretion of
bile. At the same time another effect is produced by the same cause.
The portal circulation, at first impeded by meeting the reflux from the
vena cava, is presently reversed, and the blood is thrust back into the
mesenteric veins, till it distends their extreme ramifications on the mu-
cous membrane, where it finds a species of vent ; for from this surface
the repelling force squeezes out the fluid portion of the blood into the
bowels, carrying with it the mucous epithelium, and constituting that
serous or rice-water evacuation, which is esteemed characteristic of
Cholera, but which has no title whatever to the name of secretion, or
to be treated as such, being a mere exudation, which is the very re-
verse of a vital action."

That these are the direct effects of too much blood being driven in
upon the right side of the heart, and that by diminishing the volume of
this blood, the mechanical cause would be removed, and relief thus ob-
tained, is a deduction as rational as it is practical. Experience, never-
theless, proves, that the desired result is not to be attained so effectu-
ally or certainly by directly opening a vein, as by the indirect action of
scarified cups. This latter mode of abstracting blood not only acts
beneficially by relieving congestion, but the counter irritation excites
the general circulation by continuous sympathy, and what is of more
importance, aids in relaxing the spasm of the capillaries. Every thing,
however, as we found by practice, depended upon the time and mode of
this application. If resorted to when the exudation from the skin or
bowels was yet flowing freely, and the pulse and other signs indicated
that the heart was laboring with unabated vigor, scarified cups invaria-

502 The New-Orleans Medical and Surgical Journal.

bly proved salutary ; they not only relieved the suffering organ by ab-
stracting blood from the circulation, but the heart was also afforded
time to accommodate itself to the altered quantity of blood. At the
same time, while applying the cups immediately over the congested re-
gion, blood was drawn precisely from the part where it should be taken,
and the benefits of revulsion procured by making the scarified openings
on the skin so many points of afflux ; thus opposing a temporary exter-
nal congestion to a more enduring internal one. Applied, however,
when the congestive stage is passing off, and the natural warmth of
the skin is a little more extended on the neck and chest — when the pa-
tient, though still tossing about uneasily, is comparatively relieved from
his previous agony, we would exhaust the little energy and irritability
of the heart, already impaired by long continued distension, and hasten
a fatal termination.

We now turn to those medicines which will invigorate and regu-
late the system generally and control the tendency to periodical dis-
turbance ; for this is the period of intermission to which I have already
alluded, and it requires the utmost vigilance and careful observance of
the different stages of the disease to detect it. Once detected, not a
moment is to be lost.

Relying on an experience which extends through centuries, and is
the result of the observations of Physicians in every country, we lost
no time — nay, we rather anticipated the contingency by administering
iron and quinine ; iron, for the purpose of facilitating the oxygenation
of the blood, and combatting the tendency to venous congestion, and
quinine, for its acknowledged anti-periodic properties. Nor did we
rest content here, but generally applied a large epispastic over the epi-
gastrium, both with a view to its permanent counter-irritant effect, and
its well known efficacy in preventing the recurrence of irritation of the
nervous system in periodical fevers. The preferable mode of adminis-
tration, with a view of obtaining the earliest effect of the above medi-
cines, is in solution, and in such a medium as will prove most palatable
to the patient, and be most likely to insure its retention by the stomach.
Contributing to the latter end, and harmonizing well with the quinine
and iron, we sometimes added a very small portion of morphia and cam-
phor water. These latter, however, particularly the morphia, were
employed with the utmost caution, for such was the extreme impressi.
bility to medicine, that we met with more than one case in which
complete narcotism was produced by the twelfth of a grain of sulphate

Dr. Logan on the Cholera at Sacramento in 1852.

503

of morphia. When convinced of the propriety of the union of these re-
medies, the following formula was found to be most convenient.

$ Quinia Sulph. 3j

Ferri " S ss

Morphia " gr. ss

Acid. Sulph. Aromat. 3 ij

Aqua Camphorse § ij

Ft. Solutio.

The dose of this mixture was of course regulated by circumstances.
A table spoonful for the first three or four consecutive 15 minutes,
seemed generally to respond well to the indications ; and when this was
the case, a repetition of the dose every half hour afterwards seemed to
produce all the desired effect. If no decided prolongation of the period
of intermittence or repose was produced by these means, the succeed-
ing paroxysm generally proceeded to a fatal issue, as I have already
described.

Such is only a summary of the most important part of the treatment
employed by us for the disease which I have endeavored to describe as
succinctly as the nature of the subject would allow. Of course there
were other remedies and adjuvants resorted to, but to begin to mention
these, or even to enumerate the many exigencies and peculiarities con-
tinually presenting and requiring a modification and variation of the
febrifugum magnum, or the other sheet-anchor of safety, cucurbita scari-
ficata, would occupy more space in your Journal than my deference to
the scope of your views will allow me to occupy.

P. S. Just before closing this well written paper by Dr. Logan, news
reached us of the terrible conflagration of Sacramento City, and we
perceive with the deepest regret by the papers that Dr. Logan has been
a severe sufferer thereby, (Ed,)

|)art 0cconb.

EXCERPT A.

I. — On the Climate and Diseases of California.

BY DR. BLAKE.

The investigation of the modifications produced on diseased action by the
influence of external circumstances, opens an interesting field to the researches
of the medical philosopher ; for it presents an example of an experiment made
by nature on a vast scale, in which some of the most important elements modi-
fying disease are so completely changed, that we have an opportunity of ob-
serving the phenomena they present, under circumstances which would never
have been produced by artificial means. This consideration invests the sub-
ject of the investigation of disease in this country with a degree of interest
which renders it worthy the attention of those who take a pleasure in eluci-
dating its complicated phenomena ; and whilst fully realizing the importance
of such an investigation, I have to regret that the data which a limited prac-
tice has enabled me to collect can throw but little light on the subject. The
facts, however, that have been observed, in relation to the climate of our win-
ter months, will probably be interesting to many of your readers. The data
recorded have been only those which are likely to influence the progress and
character of disease, and, as it will save space, I will present them in a tabu-
lar form.

Excerpta.

505

Nov.

Dec.

Jan.

Feb.
1 to 16.

March
8to31.

April.

Mean temperature

51°

44.6°

47.7°

48.2°

52.2°

60.7°

Highest temperature

Lowest temperature

Mean of maxima -

66.2

64.4

66.6

77.5

Mean of minima -

42.6

37.2

37.8

49.3

Mean temperature of north winds

Mean tempetature of south winds

49.5

50.7

Mean minima of north winds

39.5

49.2

Mean minima of south wTinds

38.5

48.5

Number of days of north wind

Number of days of south wind

Number of calm days -

Number of clear days .

Number of cloudy days -

Number of rainy days -

inch.

inches.

Amount of rain -

2.7

2.5

0.7

2.5

1.8

From the above table it will appear that the most important feature in the
climate of this country, during the winter months, is its equability. In no in-
stance has the thermometer fallen more than 21 ° below the mean tempera-
ture in any one month, and the difference between the mean temperature ta-
ken at the coldest part of the day, and the lowest temperature observed during
any month, does not exceed 11 ° . This fact presents a striking contrast with
the variations of temperature observed in the Atlantic States, where it is not
at all uncommon to find the thermometer descending thirty or forty degrees
below the mean temperature, even of the minima. In Rome, where the aver-
age temperature of the winter months is about the same as here, the thermo-
meter sometimes descends as low as 23 ° , whilst here it has not been noted
below 26 ° ; and there can be no doubt that the winter of 1850-51 was a cold
one, on account of the absence of strong southerly winds and rain, which are
always accompanied, during the winter months, by a higher temperature. From
all I could learn from those who had been in the country for many years, the
temperature of 26 ° was a cold they had never before experienced. This sea-
son, 30 ° is the lowest point that has been reached ; in fact, the temperature
of the winter months is most congenial, being generally about 36 ° at
sunrise, rising to about 60 ° through the day, and again falling towards eve-
ning.

The direction of winds in this part of the valley is, as a general rule,N. and
S., or varying but very slightly from these points. I have never observed an
easterly wind ; and this absence of easterly winds is a fortunate circumstance,
as regards the climate of the valley, as a strong wind from that direction,
blowing across the snowy peaks of the Sierra, could not fail to bring with it
unpleasant indications of the country it had travelled over. The influence of
the winds on the temperature varies according to the season of the year. In
the winter months the north winds are the colder, and the south winds, which,
when strong, are always accompanied by rain, are warm. Towards the spring,
the north winds become warmer, on account of the sky being generally clear
when these winds are blowing, and the sun having more power, raises the
temperature. It will be seen, however, that the mean minima of the north
winds, or the lowest temperature observed on those days on which the wind
is from the north, is still below the minima of south winds until the month of

500

The New-Orleans Medical and Surgical Journal.

April, when the summer climate decidedly shows itself, in which the north
winds are always the minima.

As regards the force of the winds, it is generally but slight ; it only blew
hard from the south twice during the whole of last winter, and the north
winds are generally very light. The atmosphere is usually calm, and only agi-
tated by slight local currents-

It will be seen also by the tables, that the sky is, as a general thing, clear,
and this is so during the only season of the year in which a cloud is ever to be
seen in the heavens. The quantity of rain that fell during the winter of 1850
-51 was about eleven inches ; there can be no doubt but that this was much
below the average, and probably not more than a fifth of what fell in 1849-50.
During the whole of the winter months the air is decidedly moist, the dews are
extremely heavy at night, the air is frequently loaded with fogs in the morning,
and it is rare to see a difference of more than six or eight degrees between the
wet and dry bulb thermometers.

On account of being engaged in geologizing in the mountains during the
summer, I have not any extensive series of observations showing the nature of
the climate during this season. The principal characteristics of our summer
climate are, a high temperature during the day, cool nights, and a dry state of
the atmosphere. From some few observations made at Sacramento, during
the months of July and August, the average temperature at sunrise was 63 ° ,
at 3 P. M. 94 ° . The highest temperatare noted was 98 ° , although I was
not in the valley during the hottest days. On one occasion, last summer, the
thermometer rose to 106 in the shade ; this was in the mountains, and it is
probable that the thermometer was almost as high in the valley. During the
summer months a southerly wind generally prevails, rising about eight or nine
o'clock in the morning, and continuing until sunset, or even during the whole
of the twenty-four hours. This tends to moderate the temperature, tempered
as it undoubtedly is, by the cold sea breeze that blows so constantly on the
coast. The hottest days are those on which the wind is from the north, loaded
as it is with the heated air of the valley between the Sierra and coast range.
But the most important element, as regards the summer climate, is its hygro-
metric condition. From observations made in July and August, the mean
quantity of humidity contained in the atmosphere was not, during the hottest
part of the day, more than 40 per cent of that required for its saturation, and
1 have not seen it rise above 74 per cent even at sunrise. In September and
October the temperature becomes lower, and at the same time a considerable
change takes place in the condition of the atmosphere. The sky still remains
unclouded and the weather dry ; but the winds, which are rarely absent dur-
ing the months of May, June, July and August, are now seldom felt, and
the air becomes more moist. The mean of some observations made in Sep-
tember gives 80 ° as the mean maximum, and 60 ° as the mean minimum.
The atmosphere at the maximum contained 66 per cent of moisture, and in
both it had increased to 73 per cent, although no rain had fallen. I will
close my observations on the climate of this part of California by a few gen-
eral remarks.

The data, as far as they go, show that the temperature of the winter
months is about the same as that of Rome, without being subject to such va-
riations as are experienced in that climate. Another advantage also which
it possesses over the climate of Italy is, that here the rains are always accom-
panied by warm winds, whilst at Rome the atmosphere is frequently exceed-
ingly cold and chilly in rainy weather. As before stated, I believe that the
temperature of the winter 1850-51 was below the average. The temperature
has certainly been milder during the present winter ; the thermometer has
not been lower than 30 ° , and at that point but on one occasion. During the

Excerpt a.

507

summer months the weather is most agreeable ; for notwithstanding the high
temperature, the constant breeze and the dryness of the atmosphere prevent
the system from being oppressed by the heat; whilst the wet bulb thermome-
ter ranges from 60 ° to 70 ° , even during the hottest part of the day, there is
no danger of the human frame, with its large evaporating surface, being in-
juriously affected by heat. The only period at which the heat is felt oppres-
sive, is in the months of September and October ; a temperature of 80 °
will produce more inconvenience here than a temperature of 96 ° in the
month of July, on account of the difference in the hydrometric state of the
atmosphere.

These observations regarding the climate of this country will apply only
to the valleys of the Sacramento and St. Joaquin, or the district comprised
between the Sierra and the coast range ; and as a short notice of the topo-
graphy of the valley may be useful, I will, before commencing any remarks
on the diseases, give its general outlines. The valley extends a distance of
about five hundred miles north and south, varying in breadth from forty to
eighty miles, from the lower hills of the Sierra to the coast range of moun-
tains, the west of Sierra being from sixty to one hundred miles farther to the
east. Through the valley run the Sacramento, coming from the north, and
the San Joaquin from the south. These two rivers drain the waters from the
western slope of the Sierra, and from the eastern slope of the coast range.
They find their way to the ocean through a considerable break in the coast
range. The rivers are bounded on each side by extensive flats, subject to
annual overflow, and forming an immense extent of marsh land ; these flats
are intersected in all directions by extensive sloughs and lakes, which fre-
quently have no communication with the river except at the time of high
water ; in fact, as a general thing, the immediate banks of the river form the
highest part of the country, so that when the waters fall after an overflow, a
very large extent of country is left undrained, from which the stagnant wa-
ters are gradually dried up by evaporation under the rays of a powerful sun.
At the time of writing this, the water is covering an extent of country ten
or twelve miles in breadth, and in some places much broader. The soil of
the valley is a fine alluvium, in some parts sandy, in others composed of te-
nacious clay. These superficial layers repose on alluvial strata, which, be-
ing generally gravelly, allow, I believe, the water to drain off to some ex-
tent, although there is always a very large surface from which it disap-
pears but by the slow process of evaporation. The short time during which
I have been practising in the Sacramento would not justify me in going
into any details, or attempting any generalizations on the diseases of this cli-
mate. I propose merely to make a few observations on some of the cases
that came under my care, and I have appended a list of the cases admitted into
the State Hospital in this city, although that institution receives by far the
greater part of its inmates from other portions of the State.

During the months of October and November, 1850, the principal diseases
were dysentery and diarrhoea ; 85 per cent of the cases I attended during
these months, we re of that nature. The dysentery was of a very untractable
character, wearing the patient down by frequent bloody discharges, and even
when checked being constantly reproduced. It was very fatal ; in the absence
of any positive data, I believe 30 per cent of those attacked died. The great
mortality was not so much owing to the virulence of the disease itself, as
to the peculiarly unfavorable circumstances in which those attacked by it
were placed. By far the larger part of the sick, probably 90 per cent, con-
sisted of emigrants, who had just crossed the plains, having accomplished
a journey, which, at all times fatiguing, was in the year ] 850 attended with
the most trying circumstances. By far the greater number of emigrants who
arrived here in the autumn had not only been broken down by fatigue, but

508

The New-Orleans Medical and Surgical Journal.

had been forced to subsist on a short allowance of food, and that frequently of
a bad quality. Under these circumstances it is not surprising- that the first
opportunity that was afforded them for satisfying their appetite should have
been made an occasion for overloading the stomach, and thus producing diarr-
hoea. The sudden change from the dry, bracing atmosphere of the interior of
the continent and the mountains, to the comparatively heavy, warm air of the
valley, exerted a most depressing effect on the system. On this point lean
myself testify ; for although without any apparent sickness, yet for the first
three weeks after my arrival in the country, from crossing the plains, 1 was so
prostrated that I could lie on my bed during the whole day, without the slight-
est energy, either physical or mental, and many of my friends were affected
in the same way. Disease, I believe is often brought on by men attempting
to work while in this state of prostration. The diet, also, was a fruitful
source of disease, not only as regards its quantity, but even its quality. The
only fresh meat to be had was beef, and this was generally fried, or rather
boiled in rancid lard ; the flour was to a great extent damaged, and the butter
and salt meat were all more or less rancid. I state these facts to show, that
although diarrhoea and dysentery prevailed here to so great an extent, and so
fatally, during the fall of 1850, the causes of its ravages are to be looked for
principally in the unfavorable circumstances in which the population was pla-
ced, rather than to any malarious influence. But not only were these circum-
stances fruitful sources of disease, but they presented an almost insurmounta-
ble obstacle to recovery, even when the more violent symptoms had been sub-
dued. There was no such thing known here as that valuable hygienic remedy
called nursing. From the toast water of the sick room your patient had to go
back to the beef, salmon, and rancid grease of the boarding house. There
were none of those light and valuable edibles which gradually lead the invalid
by a safe path back to his ordinary diet. Relapse after relapse occurred, and
it wanted but little assistance from the diarrhoeic influence which generally
precedes the appearance of cholera, to produce a state of gastro-enteric disease
amongst four-fifths of the newly arrived population.

In this state of the general health, the cholera made its appearance about
the beginning of November, and never did it fall on a population so prepared to
yield to its ravages. Although it. is impossible to obtain any accurate data as
to the number of its victims, yet I am confident that during the few days at
which it was at its height, not less than one per cent of the population was
daily carried off by it. There was nothing peculiar in the disease as it oc-
curred in this country ; its apparent virulence can be accounted for by the pre-
vious state of those attacked. The tables appended, showing the returns from
the State Hospital in this city, prove that even during the summer and autumn
months there is very little tendency to gastro-enteric disease, at least when the
exciting causes above alluded to are absent.

The diseases more particularly characteristic of the winter months are typhus
fever, rheumatism, erysipelas and pneumonia. The cases of typhus that came
under my care were of a mild form, although generally lasting from fourteen
to twenty-one days. In none of the cases which I treated did any unfavorable
symptoms present themselves. The treatment was purely expectant, with the
exception of quinine or bark, and stimulants towords the latter period of the
disease. In two instances, the rose-colored spots were noticed on the sixth day
of the disease. From the returns of the State Hospital it would appear that
this disease was prevalent duriug the autumnal months of last year, and the
mortality was 39.7 per cent, a decidedly large mortality. There were only
three cases admitted from the city, the others being brought in from the
country.

The cases of pneumonia showed themselves soon after the first rains, and

Excerpta.

509

could generally be traced to exposure to wet and cold ; they were very amen-
able to treatment. But three cases came under my care, and in every case
the patients made a rapid recovery— the time of treatment averaging nine
days.

Rheumatism was one of the most common diseases during the winter
months of '50 and 51, attacking principally those who had been previously
affected by diarrhoea and dysentery ; and in these it generally presented itself
with very troublesome, and in fact alarming symptoms. The disease was ge-
nerally of a low type, and in every case that came under my care, was accom-
panied by inflammation in the muscles, or at least in the aponeurosis ; this in-
flammation was the principal and most distressing symptom. In two of these
cases suppuration took place; in one subject in the calf of the leg, under the
glutens maximus and under the trapezius ; and in the other in the calf of the
leg. In tbree other cases that I had treated, these swellings were present in
the calf of the leg, and although I was led strongly to suspect that pus had
formed, yet they recovered without any abscess being opened. Pericarditis
existed in three cases, but notwithstanding the unfavorable character of the
general disease, this complication did not present itself in a severe form. One
of the cases terminated fatally — that in which the matter had formed so ex-
tensively. I believe the case would have been saved had it remained under
my care ; I was, however, superseded by a herb doctor, whose first care was to
bind up the abscesses as tightly as possible, to prevent the discharge from
weakening the patient. The treatment adopted was the administration of col-
chicum and quinine, and sometimes sulphate of iron ; recovery was slow ; the
average time of treatment being forty-one days. I had an opportunity of see-
ing some other cases in which the same symptoms showed themselves. Rheu-
matic affections are not so common amongst the mining population as we
might be led to expect from the exposure to which they are subject, working,
as too many of them do, for hours at a time in the water, and also frequently
exposed to rain. But very few cases of this disease have been admitted into
the Hospital during the past year, and this is probably owing to the absence of
diarrhoea and dysentery, which seem to exert a peculiar influence in predispos-
ing the system to rheumatism.

Erysipelas is a disease which has been extremely fatal in the country dur-
ing the last twelve months ; but it existed to a greater extent in the mountains
than in the valley. During the course of last winter five cases came under
my care ; in all of these the head was the only part involved, with the excep-
tion of one, in wmich the inflammation spread to the shoulder and chest ; three
of these cases occurred in the same house, and the first case that showed itself
was in a man who had been living in another house in the country, where
there was a case of the disease. The most striking peculiarities of these cases
were the inflammation of the mucous membranes communicating with the na-
tural openings, and the absence of that amount of general and cerebral dis-
turbance which so often renders erysipelas of the head a formidable disease.
In every case, the mucous membrane of the mouth and fauces was inflamed ;
in four cases there were ulceration and discharge of fetid pus from the nos-
trils : in three cases the palpebral conjunctiva was severely affected ; and in
four of the cases there was discharge of pus from the ears. And yet, not-
withstanding these symptoms, the cases in which they presented themselves
were attended with as little cerebral and general disturbance as any I have ever
seen, in which the head was involved. The fever never rose high, nor was
depletion required in any case. A dose of blue pill and castor oil, and then
quinine, combined with small doses of blue pill and rhubarb, was the treat-
ment usually adopted. The only case that terminated fatally was a man of
intemperate hab'ts, who died from a complication of the disease with pneumo-
nia. The average duration of the treatment was nine days. The disease is

510

The New-Orleans Medical and Surgical Journal.

of frequent occurrence in the mountains, and I have seen many cases of it dur- -
ing the summer. The localities where it mostly prevails are the deep valleys
in the mountain districts, which are shut in on all sides hy high hills, where
the extremes of temperature are great, and the air has a tendency to become
stagnant. In some of these places it has proved extremely fatal, the mortality
being more than fifty per cent. This large mortality is to be accounted for
partly by the intemperate habits of many of the subjects attacked by it, but
also in a great measure, I believe, from the too general use of calomel, and
from not giving quinine and tonics at an early period. In two of the cases that
came under my care, granular conjunctivas remained as a sequela of the dis-
ease, and I have seen some very severe cases of this affection that have been
produced by it.

Diseases of the air-passages are extremely rare. A mild form of catarrh
showed itself, apparently in an epidemic form, in February, 1851, and the same
affection is occasionally met with during the winter months ; but I have not
yet seen a case of acute bronchitis, and the experience of many of my medical
friends is to the same effect. This is probably owing to the absence of cold
dry winds during the winter months. Very few cases of phthisis are met with,
considering the circumstances in which so large a portion of the population
is placed, and which in other climates could not fail to develop the latent germs
of this disease which exist in so many individuals. Speaking from my own
limited experience, it is more amenable to treatment here than in any other
country in which I have practised- Two cases of the disease in an early stage
have come under my care, occurring in individuals who had a strong constitu-
tional tendency to it; in each case hsemoptysis to some extent had occurred,
and that partial solidification of the lung, indicated by the prolonged rough ex-
piratory murmur evidently existed. One of these cases has apparently quite
recovered, the individual having enjoyed good health for some months. The
other case is improving, having gained six pounds in weight during the last
month ; cod-liver oil, with quinine and iodide of iron, has been the remedy used
It is an interesting fact that in neither of these cases was any marked symp-
tom of bronchial irritation present, and I believe the exciting cause of the dis-
ease had, in each case, been improper diet, or living too Jong on salt meat,
which was probably rancid. A better diet was ordered, and strictly adhered to ;
and it is the advantages derived from this, and also from the complete absence
of any source of bronchial irritation, that have rendered the disease so amena-
ble to treatment. Many cases prove fatal, as well here as elsewhere ; but I
believe that the climate of this country presents advantages such as are not to
be found in any other part of the civilized world, for the treatment of phthisis
in its early stages.

The diseases arising from malaria might be expected to be very prevalent
in the valley of the Sacramento, containing, as it does, thousands of acres of
land subject to annual overflow, and from which there is no escape for the wa-
ter except by the slow process of evaporation, under the rays of an intensely hot
sun ; yet, notwithstanding this, cases of intermittent and remittent fever are
comparatively rare in this part of the valley. A few mild cases of intermittent
fever occurred in the neighborhood of the city last spring, but they appeared
to be confined to low localities, which are situated in the immediate vicinity of
stagnant water. I have heard of but two cases of congestive fever, and both
of them on low bottoms, near the American River, about three miles from the
city. As a general rule, the city is exempt from any of the more violent forms
of malarious disease ; a few mild cases of intermittent and remittent fevers
occur, but they are comparatively rare. The whole number of cases admitted
into the hospital in this city, which originated in Sacramento, was twelve dur-
ing the last summer and autumn. But although the influence of malaria does
not show itself by producing any of the more marked forms of disease by which

Excerpta,

511

its presence is usually manifested, yet we have constant indications of its ex-
istence, by the character it impresses on almost every form of disease occurring
in this locality. It would appear, that when in the usual state of health, there
are very few individuals in the community who are susceptible to its influence,
but when the resisting powers become weakened by any form of disease, the
malarious influence then makes itself felt, modifying, to a greater or less ex-
tent, a very large amount of the cases of other diseases. This influence it is
often difficult to detect, it is not manifested by any marked symptoms of in-
termission or even remission, but can only be suspected from the apparent ob-
stinacy of the disease, and from the effect of treatment. Dysentery, diarrhoea,
erysipelas, rheumatism, chronic gastritis, and even pyrosis, cases in which the
remedy might appear to be strongly counter-indicated, were benefitted by the
use of quinine, and in fact would not yield without it. This modified exist-
ence of malaria, in a locality where the elements from which it is generated
surround us on every side, is probably to be accounted for by the dryness
of the atmosphere during the hottest months in the year ; to the moderate
temperature that generally prevails when the amount of humidity in the at-
mosphere would favor its propagation or effusion; to the prevalence of con-
stant breezes during the summer months ; and to the coolness of the nights,
which conduces to refreshing and invigorating sleep.

As regards the number of cases of bilious remittent reported to have been
admitted into the Hospital, I believe they were for the most part cases of the
mildest form of remittent fever. I understand from many medical gentlemen
who practised here during the summer, that they did not see a single case of
bilious remittent, and the short time the patients remained in the hospital — on
an average eight days — would indicate a very mild form of remittent fever.
From the most accurate information I could acquire, (for no records are kept)
the greater number of the cases came in from the upper part of the valley,
more particularly above Marysville. Scrofulous diseases are rarely met with,
and I believe the climate will be found to offer the most favorable conditions for
the prevention and cure of this class of diseases.

Diseases of the skin are rare; eczema is the only one I have met with. Ony-
chia is common among the mining population, and slight wounds on the hand
are apt to prove troublesome ; this is probably owing to the nature of the diet,
for even when wholesome articles of food can be obtained, they are generally
spoiled by boiling them in rancid grease. The quantity of rancid grease and
salt meat eaten in this country, with apparent impunity,, offers but a poor con-
firmation of the views of Liebig, of the injurious effects of partially decompo-
sed substances on the animal economy.

Diseases of the nervous system are not very common, although I believe
forming a larger proportion in comparison to the whole amount of disease than
in the Atlantic States. A very large number of cases of insanity have oc-
curred, thirty-eight insane patients having been received into the Hospital from
May to December. This prevalence of insanity is undoubtedly owing to moral
more than to physical causes, although the extreme dryness of the atmosphere
during the summer undoubtedly renders the nervous system peculiarly excita-
ble. There is one fact with which I have been struck whilst travelling in the
mountains during the last summer, viz : the rare occurrence of coup-de-soleil.
It might be supposed that the miners would be peculiarly liable to this disease,
exposed as they are for hours to the burning rays of the sun, and frequently
with their feet in ice-cold water ; yet I have never seen or even heard of an
instance of sun-stroke, although the rays of the sun are certainly more power-
ful here than in most of the Atlantic States.

The climate in the mining regions very much resembles that of the valley,
and it is necessary to ascend some distance in the mountains before any marked
difference is noted, even in the temperature. I have no correct data on this

512 The New-Orleans Medical and Surgical Journal.

point, but the state of vegetation would indicate that there cannot be much
difference in the temperature. When I left Placerville (about sixty miles
south of Sacramento) three weeks since, or in the middle of February, the
young shoots of the buckeye were three inches long. The masoneeta (a spe-
cies of erica was in full bloom. The humming birds were building their nests,
and I believe vegetation was quite as forward, and perhaps more iorward, than
in the valley. This was at an elevation of two or three thousand feet above
the valley.

The mining regions are generally extremely healthy, with the exception of
those localities which are situated in the deep valleys, surrounded on every
side by high hills. Here the extremes of temperature are very great. As a
general thing the nights in summer are calm, and the great radiation that
takes place under a perfectly clear sky, rapidly cools the layer of air in direct
contact with the ground. This cold air can be felt running down every gulley
and ravine leading into these deep hollows, and if there is not any large open-
ing by which it can drain off, it accumulates and fills the valley with a body of
dense, stagnant air, the temperature of which descends very low before morn-
ing. In such places, typhus fever and erysipelas were very prevalent during
last summer, and were also very fatal. With this exception, the mountain
regions are very healthy ; and it is a striking fact, in confirmation of this, that
exposure can be borne here to almost any extent with impunity. During ten
months in the year the shelter of a tree is all that is required. When travel-
ling in the mountains, I always slept in the open air, except when it rained,
and I never experienced the slightest inconvenience from so doing, nor have I
ever seen any instance in which bad results followed, except in wet weather.
This is very different from what we are taught to believe as regards exposure
to the night air in the Atlantic States, with how much reason I cannot pretend
to say, never having tried the experiment. The general health of the commu-
nity is, I believe, of a higher character than in any other part of the Union ;
the complexion here generally assumes that ruddy tint, which is considered,
and justly, as the most unequivocal sign of a high state of health in individu-
als of the Anglo-Saxon race. A residence of a few months in the country is
almost always accompanied by a marked increase in weight, and there can be
no doubt but that the climate is conducive to fertility in the female. Although
I may expose mysell to the charge of enthusiasm as regards the climate of
this country, yet I am but expressing my candid opinion when I state that I
believe California will be found more conducive to the highest physical and in-
tellectual development of the Anglo-Saxon race, than any other part of the
globe. There is not a day in the year in which the powers of the mind or of
the body are enervated by heat or numbed by cold. And when the agricultural
resources of the country shall have become developed, and the swamp lands
reclaimed and brought under cultivation, I believe that every external influence
detrimental to the preservation of health, will be reduced to a minimum.

Excerpta.

513

Table showing the number of cases of the principal diseases admitted into the
Stale Hospital, Sacramento City, with their average mortality and duration
of treatment.

i T

j J une.

1-5

j August.

I September.

j October.

j November.

1 December.

Total.

Number of
deaths Pr. ct.

S -
> .

Number > f

ca~es in
Sacramento.

Intermittent lever -

1 .2

Bilious remittent fever -

116

4.3

Q
O

Congestive fever

5.00

Typhus fever

39.7

Continued fever

Erysipelas -

18.1

Diarrhoea,
Chronic diarrhoea

Dysentery -

-1

Acute bronchitis -

Chronic bronchitis

Pneumonia -

100

Pleurisy -

Acute rheumatism

Chronic rheumatism

Sacramento City, March 14, 1852.

{American Jour. Medical Sciences.)

II. — On the use of Yeast in the treatment of Boils.

BY DR. MOSSE.

I have just read a paper on the prevailing furunculoid epidemic, delivered at
the Epidemiological Society, by Doctor Hunt, at the house of Doctor Bab-
ington.

These obstinate boils are equally as painful to bear as obstinate to cure,
hardly yielding to any treatment by ordinary medicinal means, for no sooner
do you succeed in getting rid of one ere another appears, thus baffling and set-
ting at defiance most, remedies.

During a period of eight years and more, being in practice in the West of
England, where these annoyances rather raged, and were known by the name
of "pinswills," I was induced to try the efficacy of common yeast, (having
failed to give relief in general modes of treatment) in doses of a tablespoonful
with some weter, three times a day, for an adult, and smaller doses for chil-
dren.

I have now practised in this town nearly six years, and have had frequent
opportunities also here of witnessing the good effects of yeast in these trouble-
some affections, easily consummating a rapid and complete cure without fur-
ther recurrence, and by a most, simple remedy, within reach of all.

Should this be deemed worthy of observation, perhaps a place in the Lancet
may be instrumental in doing good.

(Lancet for September, 1852.)

514 The New-Orleans Medical and Surgical Journal.

III. — Suit for Damages for alleged want of Skill.

This was an action instituted before Lord Chief Justice Campbell, for com-
pensation for damages alleged to have been sustained through want of skill
and care on the part of the defendant, who is a surgeon in practice in the town
of Cowpen.

Mr. Watson, Q. C, and Mr. Blackwell, appeared for the prosecution, and
Mr. Overend and Mr. Davison for the defence.

It appeared that James Smith, a youth about thirteen years of age, the son
of the plaintiff, who is a pitman, in the early part of December last acciden-
tally fell from a limekiln, and sustained a compound fracture of the thigh bone.
On being taken home, Mr. Lynch, the defendant, was sent for, who set the
broken bone, and applied splints in the usual way. A short time afterwards
the youth had a succession of fits, and the bones were displaced. The opera-
tion of re-setting was performed, but the case which did not appear to present
any formidable difficulty in the first instance, in a short time assumed a more
serious aspect. Mr. Lynch attended his patient daily, and also obtained tbe as-
sistance of and co-operation of Mr. Cockburn, another medical practitioner
in the locality. The mother and nurse of the youth, however, seem to have
become alarmed at the symptoms presented, and discharged Mr. Lynch from
attendance, and called in Mr. Mann and Mr. Ward, who, on examination, de-
cided that amputation was necessary in order to save the life of the patient.
Before operating, however, they deemed it prudent to confer with Mr. Fife, of
Newcastle, whose professional skill and scientific knowledge, the judge re-
marked, on sending the case to the jury, would seem to be hereditary, and
whose experience enabled him to decide in the most difficult cases. Under
Mr. Fife's direction amputation was performed, and then it was discovered that
the part of the bone between the fractures had ceased to possess vitality, and
therefore never would have united.

These several parties were examined on behalf of the plaintiff", the examina-
tion being directed to show that the splints were not such as ought to have been
applied, and that the treatment of the patient from the first was improper,
whereby amputation was rendered necessary ; but on all these points the evi-
dence failed to support the case, it being admitted, on cross-examination of the
witnesses, that the splints were similar to those used in all the great hospitals
of the kingdom, and that it was the duty of the surgeon to endeavor, if possi-
ble, to preserve the limb, and only resort to amputation when there appeared
no other way of saving the patient's life.

The learned judge, on hearing the evidence of the medical witnesses re-
marked, that in his opinion the plaintiff had failed to make out his case, for in-
stead of proving that there had been negligence and want of skill on the part
of the defendant, he proved the contrary. He left that, however, to the con-
sideration of the jury, and remarked that if they wished to hear the counsel for
the defendant, they might do so, but for his own part he thought that quite un-
necessary.

The jury, after laying their heads together, determined upon hearing the de-
fendant ; after which,

His Lordship endeavored still farther to elucidate the case by a luminous
though brief address. The jury then, without retiring, returned a verdict for
the defendant. " (Ibid.)

Excerpta*

515

IV.-— On an Hospital for Epileptics.

BY MARSHALL HALL, M. D.

I have long meditated the institution of an hospital for the poor afflicted with
epilepsy. I have hitherto been deterred from prosecuting the idea by the re-
flection that it would be injurious to those liable to seizures of this direst of
chronic maladies, to be witness to the frightful scenes presented by their com-
panions in this misfortune. I believe I have, to a great degree, obviated this
objection.

Inorganic epilepsy occurs in two forms ; the first epilepsia mitior, or the
slighter epilepsy ; the second the epilepsia gravior, or, the graver epi-
lepsy.

I believe the slighter epilepsy depends on a condition of the muscles of the
neck, which I designate trachelismus, and by which the flow of blood from the
brain and spinal marrow is impeded. This is only to be prevented by strict
and persevering attention to avoid its exciting causes, which are, in general
terms, the emotions and the irritations ; the latter being chiefly dental, gastric^
enteric, uterine, etc.

But the severer epilepsy depends upon another condition — that of the larynx
termed laryngismus. As trachelismus impedes the flow of blood from the
brain, so laryngismus impedes the ingress and egress of air to and from the
lungs, especially the latter. The larynx is, in fact, more or less closed, and
upon this closed larynx violent expiratory efforts are made. These events in-
duce, in their turn, still greater impediment to the flow of blood from the
brain and from the upper part of the spinal marrow, and as a further conse-
quence, all the direr forms and effects of this dire disease, viz., convulsion,
convulsive falling, or rather dashing to the ground, etc.

Now, the influence of this laryngismus, and all these dire effects are, I be-
lieve, obviated by Tracheotomy.

The epileptic patient on whom tracheotomy is effectually performed, is pre-
served from all that is included in the graver form of the disease; and the pa-
tient may fall, but he is not thrown down violently, nor does he become affected
with deep lividity of the countenance, convulsion, foaming, etc. He no longer
presents the frightful spectacle to which I have adverted in the first paragraph
of this lecture. The objection to the institution of an hospital for these afflicted
persons is therefore removed.

Having made these few preliminary remarks, I proceed to state my views
in the suggestion that the duty of establishing an hospital for epileptics be*
comes specially imperative upon the humane and the charitable.

Epilepsy is indubitably the direst of human maladies. It dashes the afflicted
patient with convulsive violence to the ground, and exposes him to the danger
of falling — down stairs — into the fire — or water — or under carriage wheels,
and to the infliction of terrible wounds, injuries, burns, etc. It incapacitates
him for any employment. It may impair his faculties or cripple his limbs. Not
unfrequently the attack passes into a fit of mania ; occasionally it proves fatal,
by inducing a state of apoplexy, or, still more speedily, from its violence,
by spinal syncope. The ancients designated it the Herculean malady !

The epileptic becomes, then, from his peculiar helplessness and danger, the
object of our peculiar care. It is his cause which I plead.

Happily, besides the care which may be taken of these afflicted persons,
much may, as I believe, be done by carp, by regimen, by medicine, and by
new modes of treatment, to mitigate, if not to remove, their dire calamity.
Each seizure is induced by one or more of a series of exciting causes, some of

516

"The New-Orleans Medical and Surgical Journal.

which, and these the most usual, may be avoided under judicious and watch-
ful management.

The severe forms of the disease depend on the condition of the respiratory
apparatus which I have described, and which may be obviated by a simple ope-
ration. By means of this operation we are enabled to avert the violence of
the malady. We cannot, by it, avoid the cause or causes, or their first effects,
the slighter forms of the affection ; but we can avoid the severer, the graver, the
direr consequences of these causes. We can preserve the patient, as I have
stated, not horn falling, indeed, but from being dashed to the ground violently
and convulsively ; we can secure him from convulsion, and all its dire effects
on the mind and on the limbs, and save him from mania, amentia, or paral-
ysis.

Nay, we can, in a certain number of cases, yet unknown, even cure the pa-
tient ; for, by avoiding the severe forms of the disease, we obviate the suscep-
tibility to future attacks, induced and left by them. One patient, who used to
experience a severe attack twice in every week, has had no attack whatever
during twTelve months. Another epileptic, from hereditary epilepsy, during
four and twenty years, having the severest attacks frequently, and falling dan-
gerously on the fender, or into the fire, has, during four months, had the milder
attack only.

That we may take care of those poor patients ; that we may change their
malady from the direst to a comparatively, or even to a positively mild one ; and
in a certain number of cases, even cure it entirely, is certain. Who will not
lend a helping hand in so good a work ?

My project is to bring those afflicted with epilepsy under one roof, for shel-
ter, for protection, for safety ; to place them under a systematic, gentle course
of medicine, of diet and regimen, free from stimulus, of exercises free from all
effort or fatigue, of occupation free from excitement or emotion ; to arrange
their bed so that the head may be high ; to clothe them, and adopt measures
for keeping their feet warm and dry, etc. ; for such are found to be important
measures in the treatment.

Having thus done all that kindness and art can suggest for the solace and
cure of our patients, the next point is to ascertain in those whose cases prove
fatal, what are the morbid appearances on post mortem examination. These
appearances may not, as is too generally supposed, be the disease, or the cause
of the phenomena, but the effect.

Let us suppose that we meet with congestion, or ecchymosis, or a clot of
blood, or effusion of serum ; or even softening ; or, in chronic cases, induration.
Are these the disease, or the cause of the disease ? Possibly not. They are
even probably the effect of the violent congestion to which the nervous centres
may have been subjected during the paroxysms. Without attention to this
living pathology, even the morbid anatomy may lead to erroneous conclu-
sions.

Why should epilepsy, more than apoplexy, be treated empirically ? What
should we say to the proposition to trust the treatment of apoplexy to the sul-
phate of zinc, the cotyledon umbilicus, etc ? Why should we act less ration-
ally in the case of epilepsy ?

The pathology of apoplexy and the pathology of epilepsy should be equally
investigated, and upon this pathology the treatment should be founded. I would
especially recommend, that whilst every exciting cause is removed, and the
general health carefully maintained, the pilula hydrargyri be given for the re-
moval of organic effects, and the strychnia for the diminution of the suscepti-
bility of the nervous centres, equally left by the epileptic seizures.

The real value of particular remedies is also still entirely unknown, not-
withstanding the occasional publication of success.

Excerpta.

517

In an hospital for epileptics, the truth in regard to these topics may be as-
certained ; whilst we give the patients the advantage of every care, of every
aid, of every remedy.

So much can scarcely be said to be accomplished by any of our other hospi-
tals.

It is not, iudeed, yet known what may be accomplished for the epileptic by
an extreme and sustained attention —

1. To Diet and Regimen, excluding all Stimulants and indigestible Sub-
stances.

2. To the Secretions and Excretions.

3. To security against all Emotion and Excitement.

4. To Exercises and Occupations, avoiding all Effort and Fatigue.

5. To Clothing, and espicially to warmth and dryness of Feet.

6. To a raised Posture during Sleep.

I mean such a degree of attention to diet and regimen, to the secretions and
excretions, etc., etc., and so sustained as has never been attempted hereto-
fore.

The great difficulty, in the treatment of epilepsy in private practice, is the
impossibility of securing the necessary degree of attention to all this regimen.
In an hospital this will be readily accomplished. It must be the great object
of the institution.

In this manner lam persuaded that many more poor patients will recover
from epilepsy than rich.

How instructive will be a series of statistics on this subject ! The real va-
lue of regimen; the real value of remedies; the real value of tracheotomy
— 'and the real value of post mortem appearances will then become well
known.

The great difficulty, in regard te the hospital, will be that of the selection of
cases. Our expectations must be reasonable. Every one knows how little
can be expected in the congenital, the hereditary, the inveterate cases — not
from the violence of the seizures, which may be averted, but from the organic
condition, cause, or effects of the malady.

In such cases, the care of the afflicted patient must be our chief object.
But in very many others, I am persuaded, as I have stated, that we ought not
to despair of cure.

I conclude this outline with the following sketch :

1. The emotions ; 2. The irritations —induce spasmodic trachelismus.

Threatenings of 1. Apoplexy; 2. Epilepsy; or Congestion of 1. The Ce-
rebrum; 2. The Medulla Oblongata; with]. Paralytic, or 2. Spasmodic La-
ryngismus; and ]. Stertor and augmented Coma; 2. Convulsion and its ef-
fects, superseded by Tracheotomy.

Recapitulation. 1. The cases of apoplexy and epilepsy of inorganic ori-
gin have not before been duly discriminated and investigated.

2. Their causes are the emotions and the irritations ; the former acting di-
rectly, the latter diastaltically —

3. First, on the muscles of the neck, and

4. Secondly, on those of the larynx.

5. In the former case the affection designated trachelismus is the cause of
the compression of the venous network of the neck, of impeded return of
blood from the encephalon, and of

518

The New-Orleans Medical and Surgical Journal.

6. The milder forms or threatenings of apoplexy and of epilepsy.

7. In the latter case the affection is designated laryngismus, and it is of two
kinds, viz :

8. First — Cerebral and apoplectic and paralytic, with partial closure of the
larynx, assuming the form of laryngeal stertor, chiefly, but not entirely, in in-
spiration ; as in the experiments of Legallois.

9. Second — Spinal and spasmodic, with still greater closure of the larynx,
and with a still more impeded respiration, and especially of expiration.

10. The former of these is associated with apopletic coma.

11. The latter is the essential condition of convulsion, and its effects.

12. The effects of trachelismus would be superseded by venesection.

13. The effects of laryngismus are superseded by tracheotomy.

14. By this measure, paralytic laryngismus, or stertor, and its effects,
or the apoplectic state, when of inorganic origin, is either removed or miti-
gated.

15. By this measure convulsion, with its effects, is prevented.

I trust, that whilst convulsion is thus prevented, all its dire effects will be
obviated ; and that one of the susceptibility to returns, may itself subside, and
the dire disease be entirely cured.

I conclude this recapitulation by observing that —

1. The difference between the apoplexia initior and the epilepsia mitior, is
the differenee between obscure and evident trachelismus.

2. The further difference is that between psychial and spasmodic symptorasj
or that between affection of —

First — The cerebrum, and of
Second — The medulla oblongata.

3. The difference between the apoplexia gravior and the epilepsia gravior,
is that between—

First — Paralytic, and

Second — Spasmodic laryngismus.

4. Apoplexy, when extreme, is attended by convulsion ; extreme epilepsy
induces apoplectic coma, etc.

5th. Both may terminate fatally —

1. Without post mortem appearances.

2. With congestion only.

3. With the effects of this latter, viz : Ecchymosis, rupture, serous

effusion, softening.

Conclusion. — The terms trachelismus and laryngismus, which I have adop-
ted in these pages, when viewed in connection with their exciting causes, the
modes of action of these, first on the muscles of the neck and the larynx, then
on the venous network of this region, and then on the nervous centres, contain
whole volumes of living Pathology.

This living Pathology I recommend for further cultivation, in the place of
that mere caput mortuum presented in post mortem, or it might be designated
post morbum appearances.

I also recommend that this Pathology be pursued in a special manner in our
private practice. It never can be adequately investigated in the patients who
resort to our hospitals, whose cases are chiefly those of organic origin, or
involving organic disease, as effects of the previous trachelismus and laryn-
gismus.

I would finally observe, that although I have treated of trachelismus and
laryngismus as distinct, and of apoplexy as cerebral, and of epilepsy as spinal,
generally, yet each of these involve the other. Trachelismus includes the
larynx ; laryngismus adds to trachelismus and its effects. Apoplexybeg in-

Excerpta.

519

ning with trachelismus is spinal ; for trachelismus is the result either of direct
or diastaltic spinal action ; epilepsy, in its turn, is cerebral in one of its imme-
diate and many of its remote effects.

The neck, the larynx inclusive, is the medical region in which all these in-
fluences meet. By means of the structure and actions in this region, the
whole class of the diseases of the nervous centres, of inorganic origin and of
paroxysmal form, the threatenings of apoplexy and of epilepsy, are explained;
and I trust we may no longer say, with Esquirol, " Les symptomes de 1'epi-
lepsie sont tellement extraordinaires, tellement ou dessus de toute explication
physiologique ; les causes de cette maladie sont tellement inconnues que" —
etc. Indeed, I think that in few diseases are the links of causes and effects,
in a rather lengthened chain, so distinctly traced and explained. This has
been accomplished by means of the light which has been thrown upon the whole
subject of the diseases of the nervous system by our knowledge of the Spinal
System. This knowledge is as a torch in the hand of the practical Physician,
and the source of all diagnosis in regard to these diseases. Physiology, theory
and observation become allies, and lend each other mutual aid.

I trust I may be allowed in conclusion to express a hope, that the sugges-
tions which fill the preceding observations may be received with some degree
of benevolence. They are among my last legacies to my noble and exalted
profession — noble and exalted, were detraction within its own ranks, and dero-
gatory views on the part of the public, to cease, and its science to be duly
appreciated. In Medicine alone is discovery a misfortune to its author.

(Ibid.)

V. — Detection of Mercury in the body of a person dying of Mercurial Cachexy

BY M. GORUP-BESANEZ.

The subject was a woman, who for 25 years was laboriously engaged in
silvering looking-glasses, but who, from the convulsive tremors that were in-
duced, had been obliged to desist from her occupation for a year prior to her
death. The chemical results obtained by following the processes of Fresenius
and Babo, were as follows: The lungs and heart gave no traces of mercury,
a very small quantity was detected in the liver, and none in the bile. A doubt-
ful precipitate was thrown down upon the gold plate by the brain, while the
spinal column presented no traces. That any remains of it should be found
after a year is remarkable, and is confirmatory of other facts, proving how long
certain metals, e. g., antimony, may be found in the economy. That the liver
was the only organ in which it could then be detected, confirms the doctrine
that metallic poisons are usually found longest in that region.

(Chem. Gaz.—Buchnerh Rep.)

520. The New-Orleans Medical and Surgical Journal,

VI. — On the Induction of Abortion in the Vomiting of Pregnant Women.

BY MM. DUBOIS AND STOLTZ.

During a recent discussion at the Acadamie de Medecine, M. P. Dubois sta-
ted the results of his experience in relation to obstinate vomiting in preg-
nancy. In proof that this is oftener a more dangerous occurrence than is
usually supposed, he stated, that in the course of thirteen years he had met
with twenty cases in which it has proved fatal. That obstinate vomiting is
but the exaggeration of the natural sympathetic vomiting of pregnancy, and
not due to any special lesion, is proved by the facts, that at the autopsies no-
thing is found, and that when the process of gestation becomes arrested, whe-
ther spontaneously or artificially, the vomiting is ordinarily put an end to, al-
though the woman may not be delivered until several days after, of a dead child,
and may yet die of the effects of what she has already undergone. M. Dubois
refers to several cases in which the women, apparently at the point of death,
were saved by the spontaneous death of the foetus, this being expelled only
some time afterwards. In respect to the question of how far artificial interfer-
ence is attended with the same result, he furnishes notes of the four cases in
which he has employed it. Three of these cases died and one recovered ; this
last being added to other cases on record, making the number of recoveries he
is aware of 7, and probably 9. In all the cases, however, whether fortunate
or not, the vomiting was suspended by the operation. The difficulty is, indeed,
to fix the period at which this should be resorted to ; for it is the natural desire
to delay this as long as possible, which leads to the fatal result ; the woman
dying, in fact, from the exhaustion and prolonged abstinence which the vomit-
ing has induced, prior to the operation for arresting it being undertaken. M.
Dubois lays it down as a rule, never to perform it when the signs of extreme
exhaustion are present, as evidenced by considerable loss of vision, cephalalgia,
comatose somnolence, and disorder of the intellectual faculties. On the other
hand, we should also abstain from operating when vomiting, though violent
and frequent, still allows of some aliment being retained ; when the patient,
though wasted and feeble, is not obliged to keep her bed ; when the suffering
has not yet induced intense and continuous febrile action ; and when other
means still remain untried. In the first case, we should not save our patient,
but perhaps accelerate her death, and bring discredit to the operation ; while
in the other, we should sacrifice a pregnancy that might have gone on to the
full time. It is, therefore the intermediate period that should be chosen, and
this is characterized by the following signs :

1. Almost incessant vomiting, by which all alimentary substances and some-
times the smallest drop of water, are rejected.

2. Wasting and debility, which condemn the patient to absolute rest.

3. Syncope, brought on by the least movement, or mental emotion.

4. A marked change in the features.

5. Severe and continuous febrile action.

6. An excessive and penetrating acidity of the breath.

7. The failure of all other means.

But even within this period, which is of variable duration, the opportune
moment must be chosen. This seems to have arrived, when the inefficacy of
the most approved treatment has been proved, when fever is found to persist,
and the debility and wasting of the patient are making sensible progress. The
attendant should now declare that the operation is indicated, leaving to the pa-
tient and her friends the duty of deciding upon its adoption.

Excerpta.

521

Professor Stoltz, of Strasburg, has published a highly interesting communi-
cation upon this subject, in which he also states his belief that vomiting during
pregnancy is much oftener fatal than is usually supposed. He relates four
cases, from among others, that have come under his own notice. In three of
these death occurred, and life was saved by the operation in the fourth, although
the case seemed hopeless. M. Stultz lays great stress upon the operation be-
ing performed in good time, because if we wait until the effects of the sympa-
thetic reaction constitute in themselves a serious disease, the evacuation of the
womb does not induce a cessation of these, and may, in certain cases, even
hasten death — life, so to say, hanging upon a thread. It is undoubtedly diffi-
cult to say when the moment has arrived that we can no longer hope for bene-
fit from nature or therapeutical agents. But may not the same observation be
made with regard to many important surgical operations ? It is true that nei-
their spontaneous nor artificial abortion always saves life in these cases ; but
the former usually occurs only when the woman's powers are hopelessly ex-
hausted, and the pain and discharge consequent on the delivery may expedite
her end ; the same result not being infrequently seen in severe fever. Some
practitioners have expressed themselves very feelingly against sacrificing the
child in these cases ; but there is a great inconsistency on the part of those
who do so, and who still advocate the operation in the case of narrow pelvis.
A woman who has undergone artificial abortion for obstinate vomiting, may
hereafter (and these cases mostly occur in primiparae) give birth to a living
child, which can never be the case in one who has so narrow a pelvis as to
call for the induction of abortion rather than of premature labor.

{Bulletin de VAcad.—Gaz. Med.)

VII. — On the Remjval of the Obstructing Mucus in the Suffocating Bronchitis

of Infants.

BY M. VALLEIX.

In an instructive case which he relates, M. Valleix draws attention to the
importance of mechanically clearing away the mucus from the throats of in-
fants, in the suffocative paroxysms observed in the generalized bronchitis so
fatal to young children. As soon as the child assumes a violaceous appear-
ance, and suffocation seems imminent, the little finger should be passed along
the back of the tongue. The child, closing its jaws, resists strongly, but the
finger should be gradually advanced. When it reaches the isthmus, the child
opens its mouth, and we should then pass on behind the epiglottis, so as to
bring the pulp of the finger several times over the orifice of the larynx. This
produces efforts at coughing and vomiting, and the mucus is expelled from the
air passages, a part being drawn out with the finger, and the rest swallowed.
The child appears after this little operation much flushed and agitated, and al-
most suffocated ; but it soon becomes calm, until renewed signs of asphyxia
call for a repetition of the procedure. In the case which M. Valleix relates,
apparent death after one of these paroxysms was successfully treated by arti-
ficial respiration, the employment of which he strongly recommends in similar
cases.

(V Union Medicate, No. 48.)

522 The New-Orleans Medical and Surgical Journal.

VIII. — 072 an Epidemic of Puerperal Gangrenous Vulvitis.

BY M. CHAVANNE.

During the early part of the cold January of 1850, several of the puerperal
women at the Charite of Lyons were attacked, three or four days after delivery,
with vomiting- and diarrhcea, or with febrile paroxysms and abdominal pains, or
slight hemorrhage. These symptoms were followed, in twenty-six cases, by
lassitude or prostration, and lowness of spirits, and by the development of cede-
matous redness of the vulva. In a few cases the disease did not extend be-
yond this stage, active febrile symptoms becoming, however, developed ; but in
the great majority, pultaceous plates, resembling Delpech's pulpous form of
hospital gangrene, formed on the interior of the vulva and vagina, closely ad-
hering to the mucous membrane* Although their extension became limited in
a day or two, they were not separated by the inflammatory process until the
end of the first week, or during the second ; small, superficial, suppurating
wounds being left at the points they occupied, which usually soon healed up,
though occasionally degenerating, and becoming covered with the same pulta-
ceous mass.

In four of the twenty-six cases the disease extended to the uterus, and the
patients died, having presented all the symptoms of intense puerperal fever, the
gangrenous condition of the uterus becoming complicated with peritonitis. No
cause could be assigned for the development of the epidemic ; both the general
sanitary condition of the establishment, and the prior state of health of the pa-
tients having been satisfactory. In twenty of the cases the labor was natural;
the forceps, however, having been applied eight times ; and while the affection
seized some of the patients who had very easy labors, others of the inmates,
whose cases required active interference, entirely escaped. Besides the four
cases above mentioned as having proved fatal, three others of the twenty-six
died from metro-peritonitis, without extension of the gangrene. The other
nineteen recovered, the gangrene usually soon yielding to tonic regimen and
the local use of the strong muriatic acid. A very similar epidemic was ob-
served at Lyons in 1815 ; and another of the same character has recently been
witnessed in Paris.

(Gazette Medicale, No. 16.)

IX. — On a New Mode of Operating in Varicose Aneurism.

BY M. MALGAIGNE.

The difficulty which usually occurs in operating for this, in securing the two
ends of the artery, while the veins are incessantly pouring out blood, induced
M. Malgaigne to try a new plan of procedure, by which opening the sac, or the
integuments covering it, might be avoided. The case was an aneurism resulting
from venesection, performed ten or twelve years before. A small pulsatory tu-
mor existed at the bend of the arm, which caused little inconvenience. The
artery was taken up by means of two separate incisions, just below and just
above the tumor, and the cure was rapid and complete, so that when the patient
was seen seven months afterwards, no traces of the aneurism could be dis-
covered. (Rev. Med. Chir.)

Excerpta.

X. — Medicine in Syria.

Syria, like all the rest of the world, is abundantly stocked with doctors.
There are in some of the larger towns European or American physicians, some
of whom are thoroughly educated and scientific men. Most of them are con-
nected with some missionary society, or the Turkish or other government. The
London Jews Society has the accomplished Dr. M'Gowan and Mr. Sandford
in its service, at the hospital in Jerusalem. The American Board of Missions
has a physician in Sidon, another in Beirut, and a third at Mosul. These gen-
tlemen have taught a young Syrian, who is quite respectable as a physician.
The Associate Reformed Presbyterians have a physician at Damascus. There
are some Jesuit physicians in the land, connected with the missions of that
body of propagandists. The French government has a physician in Beirut,
and one in Damascus, who are well paid, besides the privilege of private prac-
tice. They report to their government what they find of disease here, for the
benefit of science in France, and also to enable the French government to jus-
tify its course in shortening the quarantine against Syria. They have physi-
cians also in Smyrna and Egypt, for similar purposes. The Turkish govern-
ment has a number of physicians in its quarantine and military service, most
of whom are Europeans, being Italians, Poles and Hungarians. All of these
gentlemen add to their incomes from the Turkish government by private prac-
tice among the European residents in the towns, and the wealthier na-
tives.

In addition to these foreigners, there is a small but increasing number of
natives, who have studied medicine in England or Egypt, or in the Sultan's
schools at Constantinople. These gentlemen vary very much in their profes-
sional attainments, and from insufficient previous preparation, and other causes,
are inferior to the European physicians here. There are other natives of good,
capacity, who by careful observation and thought) and by studying the books
printed "in Arabic in Egypt, under French superintendence, by conversation with
European medical men, so methodically pursued as to be no mean substitute
for clinical and other lectures, have attained to an amount of knowledge and
practical tact which make them highly respectable practitioners. Dr. M. Me*
shaka of Damascus, is a shining example of this. Knowing no language but
Arabic, he has acquired a sufficiency of knowledge of the sciences of the day
to enable him to pass for a well informed man in any community ; and he is a
good physician as well as an estimable man. I had no true appreciation of the
value of conversation as a means of gaining knowledge until I saw how
much this gentleman had acquired, digested, sifted, and stored for use in this
way.

Descending from these men, we find an ever-increasing number of doctors^
with a smattering of medical literature, or with none at all. Some have read
the French publications, rendered into Arabic in Egypt, just enough to spoil
their language by a mixture of French technics, and confound their brains by a
glimpse of the modern advance in medicine. Others study the old authors*
and gravely quote Galen, Avicenna, etc., as the lights of all ages, to whose
authority all must bow. Others study nothing but some pharmacopoeia of po-
pular nostrums.

The pressure of other matters keeps me from general practice, and I am of-
ten in consultation with all classes, and you can imagine the variety of author-
ity to whose dictum lam at different times expected to yield my own convic-
tions. To-day, the accomplished Frenchman eloquently explains what he has
learned of the state of the patient by careful examination, and almost confounds
me into submission to some fancy of Broussais or of Louis. To-morrow, an
untaught Syrian will assure me that opium is a cold remedy, and that all acids

52 4 The New-Orleans Medical and Surgical Journal,

injure if the chest be inflamed, and that neuralgia is wind. One asserted that
fever is a hot disease, and should have a corresponding, i. e„, a hot remedy.
Luckily he thought, from the result of other cases, that cream of tartar is a hot
remedy, and this double blunder saved his patient and confirmed the doctor in
his theories. Another, having a patient with a tremulous quaking of the
head, ordered the application of a large stone mortar, which the patient was
to wear on his head until the coldness and weight of the stone should still the
quakings. In a few hours all were still in death. The favorite, indeed uni-
versal theory of this class of practitioners is, that the stomach is the great
cauldron where all bad humors are concocted. These ascending to the head,
are there condensed, and steam down (I use their own favorite illustration)
here and there causing inflammations in the parts to which they descend. Re-
turning, ascending humors are cold, as scrofula. From this theory the vulgar
name for inflammation is descent ; and if inflammation recurs often in any
particular part, the inference is that the humors have worn a channel there, and
the common practice is to cauterize with a hot iron across the supposed
track of this subcutaneous canal. I have seen a thorough burn entirely across
the forehead, to cure recurring opthalmia. The practice succeeding proves
the theory ; a very common mode of reasoning even farther West ! Actual
cautery is used extensively and in every day practice. Infants are cauterized
at the cervix for aphtha. Neuralgia is treated with fire. I have seen cautery
carried quite across the abdomen in three parallel lines for chronic diarrhoea ;
and issues are made by actual cautery as freely as blisters are used in the Uni-
ted States.

Local blood-letting as well as general, is practised extensively. Leeches are
found in the interior, and are gathered for export in large numbers. Scarifica-
tion is employed in the case of young children. Often an infant will be put
tinder the razor of a barber, who coolly makes deep or superficial gashes on
the calf of the leg or along the back. A stout man with florid face, complain-
ing of headache and giddiness, had a string drawn stoutly about his neck until
his face became almost purple. A razor was placed on the tip of his nose and
struck sharply with a stick, so as to slit the tip of the nose, and thus extract
the blood, in imitation of nature, which so often cures the headache by
epistaxis.

The surgeons of Syria are generally barbers — many of whom are dexterous
in the use of their instruments, which are very few and simple, and crude in
form and workmanship. I have a neighbor, who has no knowledge of anatomy
and cannot read, who has operated for stone with success repeatedly, although
not always. Some native oculists operate for cataract by puncturing the scle-
rotic with a common lancet, and depressing the lens with a probe. None of
these men know any thing of anatomy, and it would seem that they are guarded
from accident by that merciful and wise Providence, which so uniformly gives
some compensation for the deficiencies which he has allowed. For instance,
the circulation of the blood is little known, and that the artery near the vein at
the elbow will not cease to give out blood as easily as a vein, is as little un-
derstood. They do not open it purposely, because it is not the custom, and I
have been able to learn of only one instance in which it was opened acciden-
tally. A native told me, that in a fleshy person, where the vein could not be
made to appear, he used to feel for the throbbing vessel and plunge his lancet
down towards it, because the vein is commonly above it. And yet he knew no-
thing of the accident of which most Western hospitals can give repeated in-
stances from their own records.

The science of bone-setting is all knack here, or innate skill. Bone-setters
are often women, or cobblers, and in the country they are commonly goat-
herds, who have gained experience by tying up the limbs of the goats which
are broken among the terraces and rocks of Lebanon. Short splints, say four

Excerpta*

525

inches long, tied tightly about the fracture, are the sole dressing. The extre-
mity of the limb swells, and mischief follows often. I was consulted a few
days since by a Druse, whose son, four years old, had broken the humerus near
the elbow. It was bandaged as above described, and as a consequence, the
fractured end of the humerus and the front of the elbow-joint were denuded
of integuments, and nearly half the flesh of the fore-arm sloughed off! A man
having had a crooked fore-arm result from such treatment, consulted his
doctor, who told him to have it broken again and re-set. He consented —
but the doctor found that the bone was strongest at the old fracture, and
broke both bones between that and the wrist. The result was a double
curve, but unfortunately the second was not so contrived as to compensate for
the first.

Teeth are extracted with the simplest forceps; and the only filling of teeth
I know of is by a priest, who first pulls the tooth, then fills and restores it. In-
deed we residents often wish that a good dentist, fully equipped, would visit
the Holy Land, and take Beirut in his way.

Had Syrians the anatomical and other knowledge requisite, they would be
no despicable surgeons. They are dexterous in all manipulations they are
acquainted with, and are acute and prompt in their reasonings and decisions.
Their fathers had a name in our profession, and the sons of this generation
need but the means and the opportunity in order to take their place among the
lights of science, as in days gone by.

{Dr. De Forest in Boston Med, and Sur. Jour.)

XL — On a case of Phlegmasia Dolens of the upper extremity, occurring after

Parturition.

BY J. M. WINN, M. D.

On the 13th of April last I was called in to see a Mrs. G., about 40 years of
age, residing near the Mile End Road, and who had been delivered of her ninth
child thirteen days before I saw her. I found her in a sinking condition. The
countenance was extremely anxious; the abdomen tympanitic and distended
to an enormous extent ; the pulse small and rapid and the mind confused.
The peculiar and very remarkable symptom, however, was a pale, hard, and
extremely painful tumefaction of the whole of the right arm, extending from
the shoulder, in an even and diffused manner, to the extremities of the fingers.
The lower extremities of the body were not affected.

Mr. Hall, of the Mile End Road, who was in attendance on the case, inform-
ed me that his patient had been delivered by a midwife, that she had suffered
from occasional rigors, and also from pain, without swelling, of the left shoul-
der, as if the disease were about to affect both upper extremities.

We ordered milk and brandy, but it was evident that nothing could save her,
and she died early on the following morning.

There can be no doubt that the above case was a most unusual form of
phlegmasia dolens. I cannot, indeed, find on record a single instance of phleg-
masia dolens of an upper extremity occurring after parturition. Dr. Ramsbo-
tham, in the last edition of his work on Midwifery, alludes to phlegmasia do-
lens of the arm as an occasional sequela of carcinoma mammae , and Doctors
Stokes and Graves mention similar cases as complications of typhus, but in
no instance as occurring after parturition.

526

The New Orleans Medical and Surgical Journal.

The cases which approximate most closely to the one I have instanced are
those (Nos. 1 and 2) published by Mr. Coulson, in his interesting " Observa-
tions on Affections of the Joints in the Puerperal State;" but in these cases
the disease and pain were principally referred to the neighborhood of the
joints.

I am sorry to add, that every effort to obtain a post mortem examination was
made in vain.

{London Lancet for October.'}

XII. — Case of Rupture of the Peritoneal Coat of the Uterus.

BY RICHARD LEE, B. A.

Mrs. C, aged 45, wife of an agricultural laborer, having been in good health
and occupied with her usual household duties on the previous evening, was
taken in labor with her tenth child about 4 o'clock on the morning of the 18th
of April. The pains were confined to the back, and very feeble, ceasing alto-
gether in less than an hour.

At nine o'clock a medical attendant, one Mr. Smith, arrived, and having
made a vaginal examination, gave it as his opinion that " all was going on
well, but the labor would not, be over for some time ;" when, ordering ginand
water to be administered, he left. Three doses of the ordered stimulant were
administered, and at a quarter before one the patient was suddenly discovered
to have lost all power, either of motion or speech. Mr. Smith was again
sent for. He arrived at 1 o'clock, but only in time to see her expire. No ef-
forts were made to preserve the child.

A coroner's inquest was appointed, and I received an order to examine the
body of the deceased, which I did, assisted by Mr. Cogan. The external ap-
pearance was unusually healthy, presenting no signs of emaciation or injury.
Of her previous labors we could learn but little, except that they had been
unaccompanied by any thing unusual, The muscles of the abdomen were of
natural development ; the lungs remarkably healthy, no adhesions ; heart
small and rather pale, cavities empty ; abdominal viscera healthy, but in the
cavity of the abdomen we discovered about three pints of dark liquid blood ;
the uterus appeared healthy, and of natural development ; the os dilated to the
size of a sixpence, not stained with blood at any point. Raising the uterus
we discovered, on the posterior surface, about the centre, a rupture in the peri-
toneal coat, extending transversely between ten and eleven inches, the margins
being in the centre, two and a half inches apart. Above and parallel with
this was a second rent, seven inches long and three quarters of an inch wide.
They both crossed a large vein the size of a goosequill, from which the princi-
pal hemorrhage occurred, On opening the uterus anteriorly down the middle
line, we found the whole internal surface on that side covered by an unusually
large placenta. The membranes had not been ruptured, but contained only a
small amount of liquid amnii ; also a healthy male fo3tus at the full period of
gestation, head presenting.

This case is interesting in various points, among which, by no means the
least, is its comparative rarity — the injury being confined exclusively to the pe-
ritoneum. The os uteri was thin and yielding, the liquor amnii present, though
not in large amount, and no perceptible contraction had taken place for seven
hours and a half before the accident occurred ; facts which, taken together,
would strengthen the opinion that the " walls of the uterus become expanded

Excerpta.

just previous to a contraction, on which hypothesis an accident of this kind
would easily be explained ; whereas I do not think any thing very satisfactory
can be attained if we are to regard it as the result of contraction alone.

A second question arises— would it not have been possible to save the child ?
I leave this to be answered by the profession ; but for my own part consider
that no means should be omitted by a medical man to save Uie life even of an
unborn foetus. (Ibid.)

Yes, by the Caesarian operation.

(Ed. N. O. Med. and Surg. Journal)

XIII; — Camphor an Antidote for the poison of Strychnine,

BY I. PIDDUCK, M. D.

In Mr. Cooper Foster's paper on poisoning by Strychnine, which appeared
in the September No. of the Lancet, he states that "no antidote is known."
The following case will help to supply the deficiency.

J. ,W., piano-forte maker, a weakly man. of intemperate habits, accustomed
to work in a hot work-shop, and to exposure to cold on his way to and from
work, was the subject of severe attacks of rheumatic gout. After one of these
gouty rheumatic attacks he was suffering under dyspepsia, neuralgic pains and
general debility. For the relief of these symptoms strychnia was prescribed, in
the dose of a sixteenth of a grain three times a day. By mistake at the che-
mist's, (one of the first in London) the grain of strychnia, with sugar, was
divided into six instead of sixteen powders.

The first dose taken in the evening produced severe twitchings of the mus-
cles ; but the second dose, early in the morning, threw him into violent convul-
sions. The messenger who came for me said he was dying. Immediately
on discovering the mistake, and witnessing one of the frightful paroxysms, I
prescribed twenty grains of camphor in six ounces of almond mixture, one
fourth to be taken every two hours. The first dose so completely quieted the
convulsions that there was no need of a second.

Cases of this kind rarely occur, and I have only this one to adduce, but the
incompatibility of strychnia and camphor proves, pro tanlo, that the one is the
antidote to the other. As a general rule, to which there probably may be many
exceptions, the poison and the antidote severally are to be found in the three
kingdoms of nature.

(London Lancet for November.)

528

The New-Orleans Medical and Surgical Journal,

XIV. — On a Case of Poisoning from swallowing Chloroform, and on its ad-
ministration in Lead Colic.

This occurred in a case of severe lead colic* for which the chloroform was
given internally with advantage, when on the eighth day of treatment the pa-
tient, by mistake, drank a draught from the bottle containing the chloroform.
The burning sensation produced informing him of his error, he drank large
quantities of water, and made ineffectual attempts to vomit. He was found a
few minutes afterwards with his eyes shining, his features animated, singing
and talking incoherently, and unable to recognise those about him ; there were
various convulsive movements, and the skin was insensible to pinching, prick-
ing, etc. The pupils acted naturally, but the power of vision seemed gone.
Pulse between seventy and eighty. In twenty or thirty minutes he fell into a
sleep, which became very deep, and was accompanied by anaesthesia of surface,
and complete relaxation of limbs, the pupils and respiration continuing normal*
Leeches were applied behind the ears, and purgative enemata given, and in a
few hours he rose like a drunken man, to fall into a sound sleep again. Next
day he could remember nothing of what occurred, and the ill effects gradually
wore off. As near as could be guessed, the man must have drank between eight
and ten drachms of chloroform; and the innocuity of so large a dose can only
be explained by the rapid elimination which Snow and others have proved that
chloroform undergoes. M. Aran thinks that in similar cases, a preferable treat-
ment would be the administration of strong coffee, and the application of cold
to the head and sinapisms to the feet — means whose efficacy is known in cases
of poisoning by alcohol, opium, ether, etc.

M. Aran speaks in warm terms of the internal use of chloroform in hysteria,
spasmodic colic, lead colic, etc., given in increasing doses from 20 to 150 drops,
in the twenty-four hours. Not only has no accident occurred to any of the
very numerous cases in which he has given it, but the physiological effects
at most in some cases resembled the transient intoxication induced by cham-
pagne. He has compared its efficacy in lead colic with that of the usual reme-
dies, especially purgatives and alum, and in a great number of cases. He does
not deny the efficacy of purgatives, and thinks that they should be always em-
ployed in conjunction; but when given alone, only very powerful ones are
efficacious, and then only temporarily so. He thinks even less favorably of
alum, as he has found it very slow in operation, and of doubtful efficacy, be-
yond enabling mild aperients to act where drastics would otherwise have
been required. Chloroform acts as opium or belladonna, by relieving the
spasms, which constitutes so important an element in the disease. It has this
odvantage, that it may be given in considerable doses, without the incessant
watching required by the other two, owing to its rapid elimination. It should
not, any more than they, be employed alone, but in conjunction with means
for ridding the economy of the lead, as sulphur and vapor baths, etc. The
chloroform is to be applied locally, and administered in a mixture, in doses of
from fifteen to twenty drops morning and evening, and as much in a glyster,
increasing this quantity if required.

(Bulletin de Therap.)

REVIEWS AND NOTICES OF NEW WORKS.

I. — Transactions of the National Eclectic Medical Association, at its
Third Annual Meeting, held at Rochester, New York, May 1st,
1852.

The transactions of this association are embraced in a pamphlet of
166 pages.

We cannot assure those who, from curiosity, inclination, or a de-
sire to take a bird's-eye view of all the novelties, and many of the fol-
lies, that are presented under inviting aspects and imposing names;
and as we must regard the transactions before us as a mixed compound
of each of these qualities ; that in the perusal of them they will have
nothing to regret on the score of wasted time, truth perverted, and the
ejaculators of cunningly devised fables attempting to win their way to
the clamosa fama, under the flimsy pretext of asserted Philanthropy,
and undying attachment to a theory, so called scientific, which is to
so change our mortal bodies, that even the decree of Deity, " that dust
thou art, and unto dust shalt thou return," will hardly find admittance
into the inductive philosophy of the zealous advocates of the new plan
of " inductive medicine."

Verily in such proceedings there exists much cause for regret, and
that men who need reformation should have become reformers, is only
an evidence of the blindness and folly which is fully sustained in theory
and carried out in practice.

To ascertain the motives which incite to action, it is often necessary
to look beneath the surface ; and in the discovery of some secret spring.

530

The New-Orleans Medical and Surgical Journal.

some mysterious contrivance, we fully estimate the chicanery and the
fraud, or the truthfulness and the simplicity, with which an undertak-
ing has been planned and executed.

When a system in religion, in morals or in medicine, has been found
by long trial and experience to be well adapted to the wants and to the
necessities of men, it is neither the part of wisdom nor of prudence to
reject the one, because she has failed to imbue all with a spirit of rever-
ence— or another, because an universal corrective has not been found
for immortality — or the third, because the only legitimate system of
medicine has been found inadequate successfully to combat every
disease.

Regarding, as we are compelled to do, the " Eclectic" movement
in medicine, as evidencing a desire amongst a large portion of its ad-
vocates for notoriety and the furtherance of sinister motives, rather than
as the offspring of universal good and the advancement of medical sci-
ence, we proceed briefly to comment upon the transactions, in order
that it may be seen if we have prejudged their productions, or dealt
other than fairly with their lucubrations.

Modesty is a quality, which, it is admitted, highly adorns a woman,
and by parity of reasoning we might infer, that a small portion of it
might enter into the character of man, without prejudice and without
taint to his fair name; such, however, seems not to be the generally
entertained opinion of medical Eclectics, as shown by the transac-
tions.

Upon the authority of the reports, we are bound to yield our ready
assent to the remarkable success of the "Eclectic Practice ;" on this
point we need only refer to the report of Dr. Skellenger on Medical
Statistics, embracing 651 cases, which occurred in his own practice in
eleven months, out of which number, we are significantly informed, he
" lost only one !" that could be regarded as his own. This statement,
coming from the author of Medical Statistics, whose report is so com-
prehensive as to embrace the singular variety of diseases named in the
651 which occurred in his practice in "eleven months," we feel al-
most implicitly bound to believe it; but were medical gentlemen of New
Orleans to venture upon a statement of such cool effrontery, we should
naturally doubt their sanity or question their veracity; and the more so,
had they consulted so extensive a glossary to give us names for disease,
the diagnosis of which would have made the most skilful hesitate ere
they hazarded an opinion.

In the closing passage of the report, the writer incontinently furnishes
us with the key to his successful practice in the following manner :

RemewL-^- Addresses, Reports, etc.

581

"Allow me to add, he writes, " that I have not performed general vene.
section in a single case." If by " general venesection" the author
means that he did not in a single case open a dozen veins at one and
the same time, he is merely stating that he was not guilty of systematic
murder upon a plan of his own invention, which, however ingenious,
might have spared him a repetition of the experiment ; but if he mean
that his " Ecclectic" tendencies were all powerful to save him from the
abstraction of a single drop of blood, he would not have been led into
the expression of " general venesection," and we might have parted
with " Report C." under the agreeable impression that the closing sen-
tence had no fault of commission.

Were we disposed to be ruffled at much of the unblushing impudence
of our rude assailants, who in no instance exhibit more "Eclectic" pro-
pensities than when amusing themselves in some fearful castigation
of those of opposing practice, we might be betrayed into error whilst
noticing the proceedings ; and lest it should be imagined that we are
disposed to condemn these " Eclectic" gentlemen unheard, they shall
in a few sentences again speak for themselves; Thus one writer in-
forms us with seeming gravity, that he " has had his hopes and his faith
severely tested, and like many of the more discerning, has almost been
led to conclude that the entire class of Physicians were a curse, rather
than a blessing to the world. But hope is dispelling these doubts. On
all sides there are hopeful indications;"

Now as this gentleman signs himself an M. D., he must of necessity
fall under the " entire" weight of his own condemnation, unless by the
saving clause he can " almost" and altogether be ready to say with
Byron, in reference to the world, that " he Stood amongst them but not
of them ;" an exclusive if not enviable right, that we shall not venture
to gainsay. " But hope," he continues, " is dispelling these doubts ;"
i. e., a doubt has suddenly sprung up in the mind of the writer, whether
as a Physician it is not " almost" unnecessary to curse himself, since
" on all sides" it is plainly avowed " there are hopeful indications."
The American Medical Association is sadly Stigmatized ; it is " most
exclusive;" it is "aristocratic;" and it " must either yield the de-
manded reforms, or be utterly destroyed." This is what Shakespeare
might have denominated, " heaven for thunder, nothing but thunder !"
But then as we do not find in this letter, which was sent from Vermont
to the Convention, on account of the unavoidable absence of the writer,
any striking evidence of fiery genius, the American Medical Associa-

532 The New-Orleans Medical and Surgical Journal,

tion may escape this threatened destruction, and carry out its " exclu-
sive" tendencies by denying admittance to every species of "Eclectic"
humbug.

The "fundamental doctrines in the faith of the Eclectic school," as
adopted by this Association, are contained in seven or eight articles.
In the 4th it is stated, " that a departure from the healthy condition of
the tissues and organs interrupts the functions of the animal economy,
and that the recuperative powers of nature only can effect a restora-
tion. Accordingly, that the object of all medication should be, not to
do the work of nature, but to afford her the means of doing her own
work, more advantageously, and under circumstances in which she
would otherwise fail.'*

Here is truth mingled with error ; the first part of the paragraph
contains a proposition which is denied in the second. " That a depar-
ture from the healthy condition of the tissues and organs interrupts the
functions of the animal economy," will not be denied ; but " that the
recuperative powers of nature only can effect a restoration," is an
" Eclectic" fallacy, of which the writer seems to be aware when he
admits that the object of medication is to enable her to perform her
work more readily, not that she is at all times alone equal to the task.
If nature only can at all times effect a restoration, " Eclectics" are
guilty of gratuitous interference with her laws, for which they should
be made amenable to civil authority.

This " fundamental" doctrine, contained in article 4th, may, at some
future time, be improved by " national" revision, or " Eclecticism"
will die a natural death.

In article 7th, we find that " the mineral poisons, such as mercury*
arsenic and antimony, and all their various preparations," are to be ex-
punged, and then with the " Eclectic" motto, of " truth and progres-
sion," " over three hundred thousand lives will be saved per annum,"
which Dr. Oldshue informs us will be " a living mighty monument !"
" Five years ago" this gentleman commenced practice in Pittsbugh,
during which time he has treated more than five thousand cases, not
twenty of which have contributed to the " Allopathic monument of
human bones /" This statement being made " to the best of my (the
Doctor's) knowledge," and having nothing to add that would improve it,
we leave him, as he himself has figuratively expressed it, " smoulder-
ing away upon the ruins of Allopathy." The first " Eclectic," we be-
lieve, who has been immolated upon the altar of opinion !

With regard to the Pathology of disease, different opinions are en-

Reviews. — Addresses — Reports, etc.

533

tertained by members of the convention, some being willing that that
subject should remain untouched, whilst others desire its partial over-
throw ; " Physiological facts, of course, must be the same in all
schools," they are willing to admit ; it is in Therapeutics that they es-
pecially desire to strike out a new course, and "instead of bleeding,"
in one of the reports upon Surgery it is written, " we administer small

doses of lobelia," which, aided with Ex. Cypripedium, Tinct.

Gelsemnum, etc., " controls muscular action." The articles used in-
stead of mercurial preparations are "Podophillin, Iridin and Sanguina-
ria."

The same writer is greatly concerned at the use of Opium, " since
nature has furnished so many pleasant and harmless things, which leave
no bad after effects, and which are so well known to the profession,
how shocking the thought that such things should be thus used !"

We are told that " the use of Croton Oil internally and externally
is barbarous ;" that death is often induced by its use, and that the
"structure of the bowels is ulcerated through." Of the effects of many
of the articles above named, having had no experience in their use, we
shall rest satisfied with the statement which has been made; but with
regard to the external (not to mention the internal) use of Croton Oil,
the writer must have alluded to its employment by some outside barba-
rians, for its consequences often to have been "most disastrous;" in its
pustular effect great good is very frequently the result, nor can we
discover any thing very " shocking" in the use of Opium, except when
some poor fanatic desires to experiment upon its suicidal effect.

We are also informed in this report, that " the lives of young and
old by thousands are daily taken ; and the united sepulchral voice of
millions slain comes up from the tomb to charge Eclectics to do their
duty to an aggrieved race." It is plain these gentlemen have no fel-
lowship with the graveyard, and hence they can pleasantly chant —

I will not have the churchyard ground

With bones all black and ugly grown,
To press my shivering body round,

Or on my wasted limbs be thrown.

With ribs and skulls' I will not sleep,

In clammy beds of cold blue clay,
Through which the ringed earth-worms creep,

And on the shrouded bosom prey."

534

The New-Orleans Medical and Surgical Journal.

It is not probable that Crabbe, when he thus versified, had " Medi-
cal Eclectics" in his brain, but we may be pardoned the connexion if

— {! On either side

The portal, friends stand guard."

We might pursue this subject much farther, were it not that prolixity
upon the follies of humanity would be an useless expenditure of time :'
we will therefore rest the merits of the " Transactions," in addition to
the foregoing extracts, upon *orfe \or two passages, which^are found tow-
ards the close of the work, and in so doing commend them to the tender
mercies of a, generous. public- . . ■ ' • \

We are told that "in' accordance with their Pathology, (i. e., with
what they are pleased to call the school of" hurikerdom and quackery"
which is soon to tumble and fall before the power of "Eclectic" sci-
ence) they will plunge the lancet into the veins," until the patient is.
brought to the " lowest point of vitality" in the treatment of fevers ;
and that "every one understands that if he is treated by an Allopathic
Physician he is to be made worse and debilitated to a low point before
he can grow better."

Such statements as these are truly characteristic, and had they been
more truthful, we might well have doubted the source from whence
they issue. Had not the writer been entirely ignorant of the course of
treatment of fevers generally employed at the present day, he woulcf
scarcely have hazarded an assertion without the semblance of truth ;
and that every body understands that " Allopathic" Physicians first
make their patients worse in order to cure them, is only

" A paper pellet of the brain"

of some gentleman who might have had the rich facetiousness of Swift,
had not nature designed him for some otl&r thing.

Dr. Dolley is also in favor of a thorough female medical education.
We are at a loss to imagine why the other half of creation should be
called upon to join an already fully stocked profession, unless it be that
the Doctor believes, that in " Ecclectics" the weaker vessel would
prove the better man.

In answer to tee Doctor's own query, " Eclecticism — what it is, and
what it may be," we do not find any very correct or definite solution ;
to choose the good and reject that which is truthful in theory or prac-
tice, is only to adopt a course which is alike consonant to reason and
good sense, and not confined in its applicability to medical pursuits ;

x. Reviews^—Dr. Wilson on Syphilis. 535

in the selection of remedies for disease, the time has not yet arrived
when a handfuil of men, with common propriety, can entirely blot out
from - our Phasrkacopises and from our practice many most valuable
agents, ^and substitute those which have neither the sanction of time,
as a tesY.of their efficacy, nor the approval of scientific enquiry, to
strengthen our belief.

In closing our remarks upon Medical Eclecticism, we leave them
improving upon the past till their next annual convention, if

« Not extinct, they hold their way
In glory through the sky."

& } ° G. T. B,

New Orleans, Dec. 1, 1852.

II. — On Syphilis, Constitutional and Hereditary ; and on Syphilitic
Eruptions. By Erasmus Wilson, F. R. S., etc., etc. With 4 Co-
lored Plates. 1852.

The author justifies the publication of another work on Syphilis, for
the following reasons : The purpose, says he, of the following pages,
is the elucidation of a subject of extreme interest, and at the same
time, one of considerable complexity. My attention, he continues, was
first directed towards it by the practical necessity of distinguishing be-
tween eruptions of the skin, which proceeded from ordinary causes,
and those originating in Syphilis ; and having before me an ample
field of research, 1 determined to investigate the subject as it was pre-
sented to myself, and without reference to the opinions and labors of
others in the same department.

Mr. Wilson has indeed studied his subject with great care, and ar-
rived at conclusions varying in some important particulars from others
who have written on this truly perplexing and complicated disease.
We shall endeavor to present, in the subjoined " notice," to the reader,
some of the peculiar views of Mr. W.

Persuaded, from extended observations, that Lupus, Kelis, Lepra and
Psoriasis take their origin in hereditary syphilis, Mr. Wilson has given
a wider range to the subject of his work than any writer of ancient or
modern times : and we believe that if the reader will follow him through
the volume, and note carefully the facts which he presents, and the rea-
sonings deduced therefrom, he will be persuaded in the end to take
sides \yith the author and adopt some of his opinions.

536

The New-Orleans Medical and Surgical Journal.

Chapter First treats of Syphilitic Poison ; Second — Primary Syphi-
lis ; Third — Secondary or Constitutional Syphilis ; Fourth — Evolution
of the syphilitic poison by the skin ; Fifth — Local actions by Syphilis;
Sixth — Congenital Syphilis; Seventh — Hereditary Syphilis; and Eighth
— Treatment of Syphilis.

Syphilitic poison gives rise to a local and a general action ; the se-
cond always follows the first, as we believe ; the one is designated the
primary — the other the secondary or constitutional disease. Nothing
is known of the physical character of the poison ; but we do know that
it enters the system by absorption, reaches the circulation, and diffuses
itself through every part of the body ; even penetrating the most solid
structures, as bones, etc. Mr. Wilson likens the mode of propagation
of the syphilitic poison to the simple process of vaccination ; the vac-
cine poison is placed in a position, says he, favorable for its action on
the tissues of the patient ; it there sets up a local or primary action,
and that local action is accompanied, after a certain length of time, by a
secondary or constitutional action.

The poison of Syphilis reaches the circulation by imbibition, whether
the surface through which it may act be broken or unbroken ; this im-
bibition of the poison by the animal tissues takes place insensibly and
slowly. During this stage of the case, and before any signs of local
lesion are manifest, the disease is said to be latent ; sooner or later, (in
from three to seven days, says Mr. W.) certain local appearances will
be seen, which will demonstrate the influence of the poison. The
local action, or chancre, so produced, is denominated primary sy-
philis.

Mr. Wilson believes that the common mode of transmitting the sy-
philitic poison from one person to another, is effected by a secretion ob-
tained from the surface of a syphilitic sore or chancre, which, when
brought in contact " with the tissues of the sound person," under favor-
ing circumstances, will give rise to the same local lesions. He further
believes that a manor a woman who may have suffered from syphilis,
and been apparently cured, can nevertheless transmit the poison to
other persons through the secretions of their organs alone. Mr. Wilson
regards this mode of transmission as of the utmost importance, and
proceeds to furnish cases illustrative of his doctrine. We believe the
doctrine sound, but do not think his cases apposite or genuine. We
think we can here assist Mr. W. in the elucidation of his point. The
case is as follows. A gentleman aged 40, of fine constitution and ro-
bust health, was married to a young, hearty and healthy woman ; in
due time they were blessed (?) with a child ; the father requested me,

Reviews. — Dr. Wilson on Syphilis.

537

a few weeks after the birth of the child, to visit the mother ; on exa-
mination, we found the mother the subject of a distinct syphilitic erup-
tion, extending over the scalp, forehead, arms, back, shoulders, etc.
The hair had grown thin, dry and lifeless ; the palms of the hands were
also the seat of an eruption. We requested to see the child ; the little
thing was delicate, thin, and very feeble ; and likewise covered with
well characterized syphilitic blotches* In conversation with the father
and husband, we learned that several years previously he had an attack
of syphilis, and as proof, pointed to the palms of both hands, which
bore indubitable evidences of previous contamination. He had no
chancres for years prior to his marriage. The wife was put upon an
anti-syphilitic course of Ireatment and rapidly recovered ; the child be-
ing nursed by the mother, received through the milk the curative influ-
ence of the medicine, and was cured as soon as the mother. This case,
backed by many others that might be mentioned, goes to sustain Mr.
W.'s doctrine, that persons may communicate the syphilitic poison by
the secretions from their organs.

The poison of syphilis maybe imbibed by an individual without le-
sion of surface, or any outward manifestation of disease ; so says Wil-
son, and we are strongly disposed to concur with him in this opinion.
We have occasionally been consulted by persons laboring under all the
symptoms of secondary syphilis, who assured us that they never had
any chancres or other local evidences of the disease ; yet the symptoms
were so well marked and characteristic of that disease, that we unhesi-
tatingly treated them for that disease, and they speedily got well. Should
we not regard this as some evidence of correct diagnosis ? Mr. Wil-
son believes that a secondary poison may give rise to a secondary dis-
ease ; or a constitutional and modified poison may produce a constitu-
tional disease without the presence of a primary disease in either the
one communicating or receiving the disease. The poison of syphilis
may, as Wilson maintains, exhaust itself, in certain persons, upon the
spot wTith which it comes in contact; or it may produce there a very
slight lesion — be absorbed, the lesion heal, unobserved, and the indi-
vidual become poisoned without suspecting by what means, or through
what channel the disease may have reached the general system.

The author asks the following important question, which is often ad-
dressed to the Physician, viz : What is the period which would be con-
sidered safe for a man to marry after he has been affected with constitu-
tional syphilis ? Before replying to this question Mr. Wilson proceeds
to explain his views concerning the law and action of the syphilitic
poison, as follows :

538 The New-Orleans Medical and Surgical Journal.

When this poison is once admitted into the human organism, it has a tendency to
accumulate until it attains a certain point, which may be termed the point of satu-
ration. As soon as the saturating point is reached, an outburst of fever, which re-
sults in the elimination of the excess of collected poison, takes place, and the system
returns to its wonted tranquility and calm. This process is repeated at intervals, un-
til after a time the intervals lengthen, and the effects gradually diminish ; from weeks
the intervals become months and years : from severe fever the attacks become tri-
vial and insignificant ; and at last the poison is so thoroughly assimilated, that it
ceases to accumulate in excessive quantities, and loses its power of exciting a febrile
action in the blood of the infected person.

But although it may be incapable of exciting disease among tissues accustomed to
its presence, it still retains the power of contaminating new blood; and it is difficult
to determine how long this degree of virulence continues. At first, probably, it may
be so far weakened, that the wife escapes, but the offspring may suffer ; and at last it
is rendered so mild that only accidental conditions call upon its powers of doing evil.
It remains, however, as I believe, lurking in the blood and in the tissues for many
years, and probably for the rest of life.

Under these circumstances our answer to the question as to the time which should
intervene between disease and marriage, must necessarily be modified by a variety
of conditions ; for example, by the nature of the secondary disease, by the known
susceptibility of the individual, by his state of health, his occupation, and by the
treatment he may have undergone ; and something must be known also of the health
of the proposed wife. Taking the most favorable view of the case, from two to five
years should be permitted to elapse, such period being passed under the close obser-
vation of the medical man.

The author recognizes five kinds of primary syphilitic chancres — the
simple, the inflammatory, the sloughing or gangrenous, the phagedenic
and the indurated ; but any of these conditions may supervene in the
course of the disease, modified by local causes or constitutional pecu-
liarities.

Mr. Wilson thinks that the sloughing and phagedsemic chancre is
rarely followed by constitutional symptoms, because the excessive lo-
cal action of the parts diseased seems to destroy the virus-forming pro-
cess ; whereas the calm and natural action present in the simple chan-
cre, seems to render the system more liable to constitutioual infection.
Phagaedemic infection is always followed by constitutional symptoms.
We here dismiss the descriptive portion of the work, and come now
to that division of the book which is the most interesting to the public,
namely, the " treatment of syphilis."

Prefatory to this subject, Mr. Wilson makes some observations on the
" prophylaxis" of the disease. He recommends a "careful washing
of the genitals with soap and ivater it should be done well and im-
mediately after connection ; and if well done he thinks it impossible
for the male to contract the disease.

But we cannot agree with Mr. W. in this opinion, since numbers
have assured us that they have tried it faithfully and fairly,and have,
nevertheless produced a fine crop of chancres, with their usual sequalae.
He thinks the female more liable to contract the disease, because of the

Reviews. — Dr. Wilson on Syphilis.

539

difficulty of cleansing all the parts with soap and water, exposed to the
absorption of the poison ; vinegar and water he thinks the best injec-
tion for females, which should be freely used after the alcaline wash.
Mr. W. thinks those who suffer a venereal sore to be developed on the
body of the penis richly deserve it, because nothing but gross neglect
could have allowed the contact of the poisonous secretion tor the length
of time necessary for absorption. Great care should be taken after
the ablution to dry the organ perfectly, lest by diluting the poison we
may render it more easy of absorption. In extreme cases of danger,
the prepared ccecum of the sheep may be used as a means of protec-
tion. So says Mr. Wilson. This means will be found invaluable to
the husband who may be afflicted with a chancre, and yet desirous of
concealing the fact from his wife.

But when the prophylactic treatment fails, (as alas ! it does too often*,
from the careless manner in which it is done) Mr. Wilson recommends
the abortive treatment for the primary pimple pustule, or chancre. If
we have reason to suspect the character of the sores, we should imme-
diately resort to the caustic ; because we do our duty to the patient, if
our suspicions are well founded ; and if not of a syphilitic nature, no
harm accrues to the patient from the use of the caustic. As a caustic,
Mr. Wilson prefers the potassa fusa, as the most effectual in destroying
the tissues upon which the poison has set up an action. The next in
order is the Vienna plaster, the chloride of zinc ; after this he prefers
the nitrate of silver. He objects to the nitrate of silver as too limited
in its action on the parts ; it does not extend its action to the depth of
the poison ; and the patient is almost sure to suffer from constitutional
symptoms after the application of the lunar caustic. He says — with a
pointed stick of potassa fusa, the surgeon possesses the almost magical
power of converting all he touches into a transparent jelly • and then
with a spunge he is enabled to wipe away the disease with but little
pain to the patient. After the application of the potassa, the patient
should remain at rest for several hours, and apply the water-dressing
to the parts. No constitutional treatment is required when the potassa
is properly applied in the early stage of the chancres— at least so says
Wilson ; we think, however, with becoming deference, that a little
blue pill, followed by the iodide of potass, will be the best guarantee
against future accidents ; and will moreover have the effect of allaying
thejust apprehensions of the patient.

Mr. Wilson regards mercury, after the venereal poison once enters
the system, as almost the only agent that can be relied upon for its ex-
pulsion ; it must be conjoined with other articles of the materia medica

540 The New-Orleans Medical and Surgical Journal,

to give it additional efficacy in many forms of syphilis. In the mean
time the patient is required to take an abundance of diluent drinks, for
the purpose of still further diluting the poison and supplying a vehicle
by which it may be carried out of the body ; at least such are Mr. Wil-
son's speculations. We have more confidence in the virtues of a tepid
bath, from time to time, to cleanse the skin, open the pores, and thus
facilitate the elimination of the poison through this immense emunc-
tional surface.

"In a word," says Mr. W., "the treatment of primary syphilis consists
in limiting supply and encouraging waste ;" but the supplies are to be
limited, not restricted ; the waste is to be economized and not encour-
aged to run to profusion.

We are forced for want of space to conclude thus abruptly our " no-
tice" of this interesting work. We may refer at a future time to some
of the views of the author ; but for the present we must advise the
reader to call on T. L, White, Canal street, buy and read the work.

II. — The Hydropathic Encyclopedia, a System of Hydropathy and lly-
geine. By It. T. Trall, M. D.

Dr. Trail's first volume is principally confined to outlines of the vari-
ous branches of medical science, illustrated with numerous engravings,
and differing in no essential point, that we have discovered, from many
other text books of Anatomy and Physiology. Passing over this de-
scriptive part of the work, we are at once brought in contact with the
erratic propensities of Dr. Trail, as he proceeds to explain his water-
cure processes. Ultraism is an unfortunate quality of the minds of
many men ; with such the most extravagant opinions are entertained
with all apparent sincerity ; nor are we at all times at liberty to doubt
the motives, however we may question the propriety or the truth of
certain doctrines which are endeavored to be inculcated. With Dr.
Trail, the element — water, is every thing ; all rules, all practice, all
doctrine, must be brought under the dominion of water, assisted, it is
true, with those hygeinic agencies which enter into the materia med-
ica of every hydropath, such as " air, light, food, temperature, exercise,
etc., etc." These agencies, it is maintained, are sufficient to sustain
every living animal in existence, as far as regards functional derange.

Reviews.- — Dr. Tralll on Hydropathy.

541

ment ; and farther, " that a full knowledge of all the remedial resources
of hygeine, with the possession of all the means afforded by such
knowledge, enables the hydropath to dispense with drug medicines
entirely."

Many men may find

" Books in running brooks,
Sermons in stones,"

But Dr. Trail eagerly eschews

" The good in every thing ;"

having found, in comparing notes with those who have used drugs in
disease, restoration to health less certain.

The high value of water as a topical agent in many surgical cases,
as also in scarlet and other fevers, is fully recognized, and its internal
exhibition in health and in disease is the true assuager of our thirst, and
were it more extensively used, medication of all kinds would doubtless
be less required.

Artificial drinks the author considers poisonous, and in every sense
inimical to the human constitution ;" under this head will not only fall
ardent spirits, malt liquors, wine and cider, but tea, coffee, chocolate,
cocoa, etc., are proscribed, and medical authorities who have attributed
to some of the former of these tonic, and to the latter, moderately
employed, slightly nutritive and refreshing properties, are held to a very
unpleasant accountability ; and of Pereira, who holds that the practice
of taking a moderate quantity of good malt liquor at dinner, is not only
unobjectionable, but beneficial, it is said, " surely his admiration of the
virtues of grog was not excelled by that of the toper."

As in drinking, so in eating, the author is primitive in his principles,
and inclines to the vegetarian mode of living, as least favorable to the
infirmities and the decay of life, instancing the rude and natural state
of mankind, when for a period of upwards of two thousand years " the
cook and the physician were equally unknown. It is to Dr. Lambe
that those are indebted who desire to experiment upon an entirely
vegetable diet, which, in conjunction with the use of distilled water,
he recommends as a remedy for cancer, scrofula, consumption, asthma
and other chronic diseases.

We had occasion some months ago, when an address came under
our notice, in which the same opinions in a qualified sense were advo-
cated, to comment thereon ; we shall therefore proceed at this time to
something more substantial.

542 The New-Orleans Medical and Surgical Journal.

Water cure establishments, in their dietary, do not exclude animal
food ; indeed in looking over their table the main difference consists in
the exclusion of porter and ale, the free use of which, in some of the
London hospitals, is mildly reproved. The writer also objects to the
use of condiments, and even sali, which we believe all orthodox medical
writers have ever considered beneficial and a promoter of digestion, are
regarded as worse than superfluous, and those who will see fit to dis-
pense with "salt, butter, cream," etc., are assured of permanent physio-
logical advantage, as amply compensating for temporary privation. Not-
withstanding that Dr. Trail states his thorough conviction " of the su-
periority of a properly regulated vegetable over the best plan of a mixed
diet," a conviction, to which we think he has gained few, if any, prose-
lytes, we find, in the chapter on " Hydropathic Cookery," many rules,
laid down for the preparation of animal food by those who cannot re-
strain the indulgence of a sanguinary appetite, which bear presumptive
evidence that in the internal arrangement of the cuisine the author is
no novice, and that in his preparation of fish, flesh and fowl, the most
fastidious taste might eat and be satisfied.

It is, however, proper to remark, that " consistently with the princi-
ples advocated in this work, all kinds of flesh-fish, all fried dishes, all
dishes cooked in butter or other grease, all minced or other meat pies,
all very oily or greasy animals or parts of animals, all and every
thing pertaining to the swine — pork, bacon, lard, sausages, etc., and
all very young and very old animals, are to .be considered as among the
things prohibited."

Abernethy, and others of like good authority, have recommended a
rasher of bacon for breakfast for dyspeptic subjects ; and the good old
practice of eating minced pies at Christmas, digested with fine sherry
and hock, is likely to prevail over vegetarian folly, and the exclusive
doctrine of Hydropathic diluents,

It is a remarkable fact, that the advocates of all the new modes and
theories, by whatever name they may be called, for giving health and
long life to man, and for restoring disordered function to its normal
condition, should, by misrepresentation, and perversion of the truth,
endeavor to cast odium upon that system of medicine, which alone
has stood the test of time, and which, in the onward march of mind,
has raised no barrier to the reception of light, no impediments to all
rational investigation, and no rejection of plans of treatment that were
divested of charlatanry. The fault, we are inclined to think, rests
with those who would have us believe that they have discovered an
universal panacea, and who, under some plausible pretext, make ready
dupes of the unwary.

Reviews.— -Dr. Trall on Hydropathy. 543':

The water cure system, at the dictum of Dr. Trail, abjures the use-
of drugs, " and depends wholly on hygienic influences." That these
influences are most potent for good, cannot and will not be denied ; that
they may be in many cases all-sufficient, is equally true ; but that we
should in all cases wholly depend upon them, to the exclusion of appro-
priate medicinal agents, is a fallacy that the author himself can scarcely
believe.

"It is no uncommon circumstance for a patient to. be dosed with a
quart of brandy, or a gallon of wine, in twenty-four hours." We
should imagine that cases requiring such an enormous quantity of
stimulus in a given time were of rare occurrence, and that if dosed in
this way without urgent necessity, the patient would soon be a fit
candidate for hydropathic interference. It is to passages such as this?
which are found scattered ad libitum through the work, that we point
for evidence of misrepresentation.

In his chapter on fevers, Dr. Trail, not satisfied with the nosologi-
cal arrangement of other authors, they being "unphilosophical and ab-
surd," has proposed one of his own, which, it is highly probable, will
fall under the same condemnation by some of his readers.

We transcribe a portion of t]ie classification :
Continued fevers.

1. Ephemeral—one day fever,

2. Inflammatory — Synochus — General inflammation.

3. Typhoid.— -Yellow fever, Nervous fever, Putrid fever, Ship fever*
Spotted fever, Camp fever, Jail fever, Hospital fever.

In giving his views of some of the types of fever, he says, " the yel-
low variety is produced by causes which especially operate to impair
the secretion of the liver, as excessive heat, animal or vegetable mi-
asms, combined with gross diet and stimulating drinks. Every kind of
animal food, except perhaps milk, in very warm climates, I regard as
a predisposing cause of yellow fever." The writer will have to find
some other rationale than this, else how will he explain the fact of deli-
cate females, or females not quite so delicate,, yet who are neither gross
in diet, nor addicted to indulging in stimulating drinks, being attacked
with yellow fever ?

Since the days of Hippocrates, we are told, the old school plan has.
been to conduct fevers through their course ; and that " by poisoning
the body through and through, with course after course of drugs ! There
is nothing known to civilization more thoroughly barbarian than the
drug treatment of a fever." To this we must give our hearty concur-

544

The New-Orleans Medical and Surgical Journal.

rence, for if our poor bodies are to be poisoned through and through,
we must die martyrs to a savage treatment, and hang the Doctor with-
out benefit of clergy !

But if Dr. Trail make the above statement in all sincerity and sim-
plicity, we must inform him that at the present day, instead of conduct-
ing most, not to say all, fevers, through their course, we cut them off,
and save our patients for a higher state of " civilization !" and this we
do through the chemical agency of quinine.

Of inflammatory fevers Dr. Trail says, "The blood is on fire; ex-
tinguish the flame, and the patient will be well." The hydropathic
treatment of this fever is, to " wrap the patient in double wet sheets,
lightly covered with bedding ; let him remain as long as he is compa-
ratively comfortable : then wash him off with cold water. Repeat the

process as often as the febrile heat increases In fact, a sufficient

quantity of cold water applied almost in any manner, will finally effect
a cure."

Water, especially in the form of ice, is certainly indispensable in
the treatment of fevers ; but having had no experience in the manner
of its employment recommended by the author, we will only remark,
that as such treatment would, in the greater number of cases, be
opposed by the strong prejudices of the patient, an instant difficulty
would occur to its employment, even were there no well grounded ob-
jection to being wrapt " in double wet sheets,"

As a book of reference, there are many things in the Encyclopedia
which may be found useful ; the word " Hydropathic" might have
been omitted with manifest propriety, had not the author an itching
desire to render his volumes attractive by the capricious employment
of a name, rather than by adhesion to the definition of terms ; but the
" elements" of Dr. Trail's mind warred against such a beaten track,
and he has given us water and vegetables to allay our thirst for hydropa-
thic information, and hygienic rules to preserve our physique from a
beggarly array of empty pill boxes.

It becomes necessary for those who scan books, and then venture an
opinion upon their merits or demerits, to take first their contents as
they are presented, and if at all times it would be inconsistent to
award unqualified praise, (our natural tendency not over -inclining to so
plastic a course) so would it be unfair too severely to condemn the er-
ratic foibles of men, who, but for some fanciful ideas, or some obliquity
of mental vision, might have been satisfied to enjoy the secret con-
sciousness af unobtrusive merit !

Reviews. — Dr. Simon on General Pathology. 545

Those who read may often now-a-days be led to feel the force of the
words of the hard, that "all the world's a stage," and although we may-
be highly amused at a good mountebank, or a really clever fool, whilst
he caters to our amusement upon the stage, we must think that it would
be no part of wisdom to write volumes upon their foibles, or attempt to
cajole us into the belief that it would be the better part of discretion
for all "men and women" to become " mere actors."

Having now passed through the volumes of Dr. Trail, we must fold
the pages to rest, knowing

" The groans of nature in this nether world,
Which heaven has heard for ages, have an end."

G. T. B.

New Orleans, Dec. 8, 1852.

III. — General Pathology, as conducive to the establishment of Rational
Principles for the Diagnosis and Treatment of Disease. By John
Simon, F. R. S., one of the Surgical Staff of St. Thomas' Hospital,
and Officer of Health of the City of London. Philadelphia, 1852.

This little volume, so full of original thought, and in many parts, of
sound philosophy, embraces a number of Lectures, delivered by Mr.
Simon to his class at St. Thomas' Hospital during the summer session
of 1850. In the study of Pathology, the blood, of course, must claim
a large share of the writer's attention ; and Mr. Simon has devoted the
first few lectures to the consideration of this important fluid. To give
the reader some distinct idea of the author's views on this part of his
subject, we subjoin the following speculation.

If this were the whole history of the blood, its investigation in disease would be
comparatively easy. But a chief difficulty in the study is this: that the blood un-
dergoes changes of its own ; undergoes what 1 can hardly call any thing else than
a process of growth. In addition to receiving new matter from the food, and old
matter from the tissues ; in addition to feeding the several organs and supplying the
several excretions of the body, it does also itself undergo, as I have said, progressive
changes of its own, analogous to the growth of the solid tissues. For the new mate-
rials which are derived to it from the food are not blood at the time of their addition ;
they are crude, immature products, which subsequently ripen within the stream of
the circulation, under the influence of the mature r blood, and conformably to its
composition. To some of you perhaps the view here suggested, of the blood under-
going development akin to growth, may be new and strange. There is an early
prejudice which makes us consider solidity of structure an indispensable preliminary
for the residence and manifestation of life. Still in spite of that prejudice, and in
spite of the fluidity of the blood, you may safely believe that that red fluid is a living
and growing mass ; that the process of blood-formation is not the mere infusion of
certain ready-made materials from without, but is as truly a process of growth as
the development of cartilage or muscle.

543 The New-Orleans Medical and Surgical Journal.

If the power of resisting change ; if the power of converting things to its own
'type, and perpetuating its own constitution be signs of life in an element or por-
tion of the body, I know none which possesses these qualities in a higher, if in
so high a degree as the blood. And further, in recalling its anatomy you will
be confirmed in this view. You will remember that in all other elements of the
body the abundance of cell development which you meet with measures the activity
and constancy of growth ; and if you put a drop of blood under the microscope
and compare it with a patch of equal size of liver or of brain, you are at once en-
abled to judge how immeasurably greater is the developmental activity in the
blood ; or if you look at a drop of fluid from the thoracic duct, you observe my-
riads of cell-germs there; germs which it is the chief and perhaps the only object
of the lacteal and lymphatic systems to provide, and which attain their maturity
and fulfil their purpose only when received into the blood.

And not only does the blood live and grow ; but in the mature animal its life
and growth must precede all other life and growth in the body ; for first it grows and
next other organs grow at its expense.

What I have said will suggest to you how many liabilities to disease are in-
cluded in the circumstances to which the blood is exposed ; how easily morbid
ingesta may become commingled with it as causes of change ; how easily matters
may be retained in it which various distant organs ought to eliminate ; how easily
its own progressive development may be interfered with, arrested or deranged.

The enumeration, too, that I have given of its functions in health, will show you
sufficiently what particular difficulties belong to any investigation of its changes in
disease. In the first place, the extreme rapidity with which all its changes occur,
the consequent transientness of the phenomena, and the minute quantities in which
several of the ingredients exist, oppose great obstacles to the research ; but -still
greater embarrassment is caused by the extreme complication of the fluid. By
complication I do not mean merely that it contains a large number of ingredients ;
but that those ingredients correspond to different dates of time, to different degrees of
development and to different organs of formation. Mentally we can see with per-
fect distinctness, that in every porringer of blood drawn by the phlebotomist there do
in reality coexist three forms of blood, viz :

1st. Blood not yet ripe, but in course of development ; perhaps I should rather
call it matter in a transition state from food to biood.

2d Blood which is already perfect, and which at the moment of its abstrac-
tion was actually doing the work of the economy.

3d. Blood which had done its work and was worn out ; or to speak more ex-
actly, the waste materia! of those various organs and tissues which the blood
had previously nourished.

Mentaiiy I say we can separate these three kinds of blood, but experimentally
We cannot ; they are mixed together — past, present and future, (the blood of yes-
terday, the blood of to-day and the biood of to-morrow) and we have no method
of separating them.

In all probability the fibrin and extractive matters represent the waste products
of the active elements of the body, and exist in the blood as effete, material in
the way to be eliminated ; representing what just now by a figure of speech I
called the blood of yesterday. Of the fibrin I shall have plenty to say presently,
and shall then explain to you why I consider it as an effete product in the blood.
Of the extractive matters I know too littie for me to say much ; hardly an en-
deavor has yet been made by any competent physiological chemist to refer them
to the several organs in which they probably originate. Doctor Franz Simon,
who has done with them more than any other chemist, divides them according to
their respective menstrua into water-extract, alcohol extract, proof-spirit extract ;
but (as I need hardly suggest to you) that is not the sort of division likely to be
useful to us in our present subject ; the only physiological division would be one re-
ferring them severally to the organs whose effete products they represent ; showing
such an one to be brain-extract, another muscle, extract, etc.

It is desirable, gentlemen, so far as may be possible in treating of blood-diseases,

Dr. SiMoft on General Pathology.

547

to contemplate them in the manner suggested in the physiological retrospect I have
made, and to take them in some such order as the following :
First. Diseases depending on morbid ingestion.

Secondly. Diseases depending on increase, arrest, or alteration of the excre-
tions.

Thirdly. Diseases depending on modification of the blood's own growth and de-
velopment.

By the foregoing quotation it will be perceived that our author ven-
tures to think for himself, and carries some of his views beyond the
doctrines of the day. How far he may be consistent with well ascer-
tained facts, we leave the reader to determine. The book is well cal-
culated to excite enquiry and stimulate the mind to further investiga-
tion ; and this is saying much in favor of the work.

We give another specimen of Mr. Simon's style, and then leave the
book in the hands of the profession. Speaking of the distinction be-
tween hypertrophy and inflammation he says —

In the chain of events which terminates in hypertrophy or inflammation; the first
act relates to the influence exerted by the elements of the part on the materials of
the blood circulating through it, and consists in an alteration (perhaps in hypertrophy
only a quantitative alteration, possibly in inflammation also a quantitative alteration)
in these changes which the part naturally works on the blood, as the indispensable
condition of growth. The growing elements of the part — hurt by physical violence,
or affected by extremes of temperatures, or thrown into rapid chemical changes, or
over-burdened with their own specific stimuli from the blood — strive to grow more
or to grow differently than in their previous state. The sudden origination of this
effort (as it occurs for instance, after mechanical injury) suffices apparently in itself
to derange the currents of the capillary circulation, to flood the tissues with seroua
exudation and to lead to those microscopical phenomena which are considered pa-
thognomonic of inflammation.

The condition of a part in which the organic changes are thus accelerated (whe-
ther in the form of hypertrophy or inflammation) is capable of inducirfg in the mus-
cular arteries which lead to it, a state of enlargement or increased perviousness,
which determines to the part a larger afflux of blood ; and it is in a high degree pro-
bable that the manner in which this enlargement occurs is by the way of what we
technically call reflexion ; that a certain impression from the part is conveyed centri-
petally by its sensitive nerves and is responded to by a return current through the
motory nerves of its artery ; that the specifie influence of this return current is toy
induce a relaxed condition of those muscular fibres which regulate the calibre of the
artery, and by this relaxation to suffer an increased transit of blood to the inflaming
or overgrowing part.

We have next to inquire what are the chief results which may arise in a part from
an augmented determination of blood thither ? what are the chief consequences of
active hyperaemia ? They van? most importantly according to the following differ-
ences :

1. The determination of blood, though over and above the usual supply, may ad-
mit of application according to the ordinary and healthy functions of the part. The
biceps muscle of a blacksmith's arm receives perhaps as much blood as all the mus-
cles of my upper extremity put together ; but there is no blood wasted ; all that goes
there is turned to account, and contributes to the increased development of a normal
tissue. Or,

2. The supply of blood may be more than can be used and appropriated by the or-
gan so copiously supplied ; and then it is that we get a continued superfluity of exu-
dation pervading the tissue, and find that superfluity undergoing an independent
development into certain shaped products— cells or fibres— foreign to the healthy struc-
ture of the part.

548

The New-Orleans Medical and Surgical Journal.

Now what I have just stated is the distinction between hypertrophy and inflamma-
tion ; their general pathology has much in common ; their causes are often alike ;
their modes of production identical. But in hypertrophy — however large may be the
supply of blood, it all goes to the true nourishment of the organ ; goes to increase the
ntimber of its natural molecules ; While in inflammation all that is redundant goes to
the formation of new products.

After what I have said of the pathological affinities of these two processes, it will
not surprise you to be told that in many organs of the body hypertrophy and inflam-
mation run into one another by almost insensible gradations ; as for instance with
secreting surfaces, where after a certain time that which produced at first a mere ex-
cess of secreted material presently causes to be mixed with that secretion more or
less albumen, fibrin blood, pus and the like.

We are very desirous to lay before the readers of the Journal other
evidences of the great value of these lectures ; but our space is too
limited, and we must content ourselves by urging the profession to
study the work with all due diligence, as it will be found much superior
to many that are now being daily thrown off from the press. White*
53 Canal street, has copies for sale.

VI. — A Practical Treatise on the Diseases of the Skin* By J. Moore Neli-
gaNj M. D., M. R. I. A., Honorary Fellow of the Society of Physicians of
Sweden, Physician to Jarvis street Hospital, etc., of the Dublin School of
Medicine, etc.

Diseases of the Skin, especially of a chronic and obstinate character, are so
seldom met with in New Orleans, that but little inducement is held out fo the
general practitioner to study their various forms and types. The fondness of
our resident population for free and frequent ablutions, and the mild and genial
nature of our climate, tend to diminish the diseases of the skin beyond a
doubt in our midst j and" when cases are imported from abroad, they yield most
read-% to the ordinary treatments

Dr. Neligan has made the diseases of the skin a speciality, and his opportu-
nities for acquiring a thorough knowledge of this branch of medicine has been
both extensive and well improved. A practical treatise, like the present, was
truly a desideratum, both for the general practitioner and the medical student.
Concise and clear in arrangement, it will meet fully the wants of the profession,
and become vastly more popular than other more elaborate and scientific works
On the subject. We love small books, and Neligan's is fashioned exactly
after our taste. The subjects introduced into the work and discussed, are too
numerous to require special notice } and after having examined the book, we
can conscientiously commend it to the medical profession. It will bear a close
examination, and will supply just the kind of knowledge required to practice
medicine successfully. Besides, it is eminently practical in its aim and objects,
and will therefore command the attention of the profession. We again com-
mend it to our medical friends.

It may be found at Steel's, 60 Camp street

}P art jTourtl),

MISCELLANEOUS MEDICAL INTELLIGENCE.

I. — Large Doses of Opium in Dysentery.

BY DR. STARR.

In the Southern Medical and Surgical Journal, for December, 1852, we find
some sound practical suggestions on the treatment of acute dysentery, by Dr.
Starr ; among which he makes the following.

{Ed. N. O. Med. Jour.)

There is no confidence to be placed in an ordinary or medium dose of opium
when the patient is suffering the effects of violent inflammatory action, the
tortures of pain, or the depressing adynamic influences of malignant disease.
The dose must be proportionate to the emergency of the case. I suggested
from two to four grains, but this should not be considered the limit ; this quan-
tity is rather the minimum than the maximum; circumstances must determine
the precise amount. In dysentery, if the pain, fever and flux persist, they are
sufficient evidence that enough has not been given ; six grains are not too
much in such cases. The ant/phlogistic virtues of opium seem generally to
be imperfectly known or understood, or if known, not appreciated and applied.
All agree in admitting its usefulness as an anodyne, as a soother of pain and
promoter of sleep, etc. ; but who administers it with the view of overcoming
fever, or who looks to it principally to subdue some severe forms of inflamma-
tion. Yet what diaphoretic will produce such certain and general opening of
the pores, and genial moisture of the surface ?— *what will so equalize the cir-
culation ? — what so control the heart and arteries ? — and what afford such
suspension of pain, thereby breaking the chain of the morbid actions of in-
flammation ? Fever and inflammation cannot well persist under such circum-
stances— under the effects of full doses of opium.

To carry out more effectually the suggestion above made, in relation to the
indications of treatment, it maybe often proper to resort to one efficient blood-
letting, in cases where there is much fever and no want of strength. This
will render the system more susceptible to the favorable influence of opium,
which now, if properly administered, will never fail to mitigate, and seldom to
relieve entirely, the sufferings of the patient. When this is done, the use of
opium is not to exclude other substances as auxiliaries ; such, for instance, as
calomel or oil, when they are needed, or sugar of lead and other astringents,
when, after the subsidence of the inflammatory symptoms, the discharges re-
main too frequent and watery. These, with fomentations, blisters, enemata
of watery solution of opium and starch, etc., may be resorted to ; but opium in
large doses, given either by the mouth or rectum, in the early stage of the
disease, should be the leading remedy and chief reliance.

550

The New-Orleans Medical and Surgical Journal.

II. — On the Crossed Transmission of Impressions in the Spinal Cord.

BY BROWN-SE QUART}.

Numerous experiments which I have performed have proved to the numerous
physicians and students, who have seen the most important of them, that the
impressions made on one side of the body are transmitted to the sensorium by
the opposite side of the spinal cord.

It is known that Galen performed two experiments, which have been consid-
ered as demonstrating that there is no crossed action in the spinal cord. One
of these experiments of Galen consisted in the transversal section of a lateral
half of the spinal marrow. After this operation the animal was paralyzed in
all the parts situated behind the section, on the same side, so that the palsy
was on the right side of the body when the right side of the spinal cord was
divided, and vice versa.

The second experiment consisted in a longitudinal section of the middle
line of the spinal cord, so as to separate into two lateral halves the part of that
nervous centre supplying nerves to the posterior limbs. After this operation
the animal was able to walk.

Galen, in these two experiments, did not examine the state of the sensibility.
He speaks merely of the voluntary movements. Nevertheless, his researches
were considered in this century as completely proving that there is no crossing
of action in the spinal cord, either for sensibility or for voluntary move-
ment.

The following experiments will prove that there is a crossing of action for
sensibility in that organ :

1. If a lateral half (i. e., the posterior and the anterolateral columns and the
gray matter of one side of the spinal cord) is divided transversely at the level
of the tenth costal vertebra, on a mammal, it is soon evident that the sensibility
is much diminished in the posterior limb opposite to the side of the sections.
On the contrary, the sensibility, instead of being lost, appears much increased
in the posterior limb on the side where the section has been made.

2. If, instead of one transversal section of the spinal cord, two, three, four
or many more are made on the same lateral half of that organ, the same results
are obtained.

3. If, instead of mere sections, the removal of a part of a lateral half of the
spinal cord is effected, the same results are still obtained. In performing this
experiment, a longitudinal section, one inch in length, from behind forward,
is made in the medial plane of the spinal marrow, and then two transversal
sections on a lateral half are made at the extremities, of the longitudinal, sec-
tion, so that a part of the cord is completely separated; from that organ and
afterwards removed.

4. If, instead of dividing entirely a lateral half of the spinal cord, a small;
part is left undivided towards the centre of that organ, the posterior limb on
the same side becomes much more sensible, but the posterior limb on the op-
posite side remains very sensible, and sometimes it appears more sensible than
in the normal state.

5. If, in performing the section of a lateral half of the spinal cord, the in-
strument goes a little too far, and divides also a small portion of the other half,
then the posterior limb on the side of the complete section is less sensible than
in the normal state, and the posterior limb of the opposite side loses completely
its sensibility.

6. if the section of a lateral half of the spinal cord is made at the level of
the second or third cervical vertebra, it is found that the sensibility becomes
very quickly much greater in the parts of the body on the same side as the
section, and on the contrary, the parts on. the other - come evidently less
sensible.

Miscellaneous Medical Intelligence.

551

7. If, after a section of a lateral half of the spinal cord at the level of the
eleventh costal vertebra, another section is performed on the other side of that
oro-an, at the level of the sixth costal vertebra, so that the two lateral halves
are divided, then sensibility in most of the cases is lost on both sides. Some-
times it retains a very high degree of sensibility, more particularly in ths pos-
terior limb on the side where the spinal cord has been divided at the level of the
sixth costal vertebra.

8. If two sections of lateral halves are made as in the preceding experiment,
but at a greater distance one from the other, on the right side, for instance at
the level of the twelfth costal vertebra, and on the left side in the cervical re-
gion, nearly the same results are obtained as to the posterior limbs, but the sen-
sibility is increased in the right anterior limb, and it remains very evidently,
but much diminished, in the anterior limb.

9. If a longitudinal section is made on the part of the spinal cord giving
nerves to the posterior extremity, so as to divide that part into two lateral halves,
then it is found that sensibility is completely lost in the two posterior limbs,
although voluntary movements take place in them.

10. If a similar separation of two lateral halves of the spinal cord is made on
the whole part supplying nerves to the anterior limbs, then it is found that sen-
sibility is lost in both these limbs, and that it is only slightly diminished in the
posterior limbs.

11. If the same operation is done as in the preceding experiment, and after-
wards if a transversal division is made on one of the lateral halves, in the place
where it is separated from the other, then it is found that the posterior limb on
the side of the transversal section remains sensible, and that the other posterior
limb loses its sensibility.

These experiments prove very clearly that the sensitive nervous fibres are
erossed in the spinal cord. The 9th, 10th and 1 1th demonstrate directly the
crossing. In these experiments the crossed fibres are all cut and sensibility is
lost. This fact appears to prove that all the sensitive fibres cross each other ;
but it will be easily understood that on account of the loss of blood, and of the
general diminution of sensibility produced by the excessive pain of the opera-
tion, if there are some fibres which remain without crossing, they are insuffi-
cient to give sensations.

As to the experiments consisting in transversal sections of a lateral half, they
prove that sensibility is much diminished in the side of the body opposite to
that of the section ; consequently they prove also that there is a crossing of a
great part of the sensitive fibres.

The fact that transmission of impressions made on one side of the body
takes place, at least for a great part, in the opposite side of the spinal cord, is
proved evidently by the eight first experiments, but much more by the 7th and
the 8th experiments, in which it is found that after a section of a lateral half
of the spinal cord, sensibility remains on the same side, and that it is nearly
entirely lost after a second section of the other lateral half in another place.

If most of the nervous sensitive fibres are crossed in the spinal cord, then it
is not exact to admit that the crossed paralysis of sensibility in cases of dis-
eases of the brain, is explained by the crossing of fibres which exists in the
pons varolii and in other parts of the encephalon. Many opinions have been
proposed as regards the place where the sensitive nervous fibres make their
crossing in the encephalon. According to some pathologists, this crossing
takes place all along the medulla oblongata, the pons varolii, tubercula quadri-
gemina, and the crura cerebri. In all these organs there is truly a crossing of
fibres, but we do not know what are these fibres. Charles Bell believes that
the crossing of the sensitive fibres takes place in the posterior surface of the
niedulla oblongata, in a great part of the length of the fourth ventricle. Lon-
get supposes that this crossing exists at the anterior border of the pons varo-
lii, where the two processi cerebelli ad testes cross each other.

552

The New-Orleans Medical and Surgical Journal.

My experiments prove that if there arc some fibres coming- from the trunk
and from the limbs which do not effect their crossing in the spinal cora* itself,
their number ought to be very small Therefore the fibres which are found
crossed in the encephalon are not sensitive fibres coming from the limbs and
from the trunk, as all physiologists have supposed they were,

My experiments were made on many different species ; guinea pigs, dogs,
cats, sheep and rabbits. In all the same results were obtained.

To ascertain the degree of sensibility, I used various modes of excitation ;
mechanical, galvanic, physical, (i. e., warmth and cold) and chemical. 1 con-
stantly compared the degrees of sensibility in the parts of the body situated
behind the injured portion of the spinal cord, with the anterior parts of the body,
and particularly with the face- It is thus that I have been able to ascertain
the existence qf an increase or of a diminution in sensibility.

Sometimes I have given chloroform to animals having had a lateral half of
the spinal cord divided in the cervical region. I have found that complete loss
of sensibility appeared at first in the parts of the body opposite to the section
of the spinal cord, the head and neck, and at last in the parts of the body be-
hind the section of the cord, on the same side. This experiment, as well as
many others, prove undoubtedly that there is an increase of sensibility
in these last parts. I will try in another article to explain these hyperes-
thesia.

I believe I am entitled to conclude from the facts above related the fol-
lowing :

1st. That most of the impressions made on one side of the body are trans-
mitted to the sensorium by the opposite side of the spinal cord, so that the im-
pressions on the left side of the body are transmitted by the right side of the
spinal cord, and vice versa,

2d. That the assumed function of the crossing of fibres in the pons Varolii,
and the neighboring parts, does not belong to these fibres, but to the fibres of
the spinal cord, all along which they cross each other.

{Phil. Medical Examiner.)

III. — Mineral Springs.

Dr. John M. Bell, of Philadelphia, who is preparing a work on Mineral
Springs, more especially on those of the United States, is desirous of procur-,
ing, at an early day, all accessible information on the subject. With this view
he requests his professional brethren to transmit to him all the facts in their
possession which may throw light on the chemical composition and curative
powers of the waters of the springs in their respective neighborhoods.

Proprietors of these waters would oblige us by sending to Dr. Bell authen-
ticated accounts on these points, and also of the topography of the springs, and
the roads by which they are approached.

{Ibid.)

N. B. Dr. B. is very desirous to obtain some further knowledge of the vir-
tues and qualities of the Hot Springs of Arkansas, and those of Cooper's
Wells in Mississippi. {Ed. N. O, Med, and Surg. Jour.}

Editorial^— City intelligence. 553

tl)e SlettJ-ODrkans UleiUal anfo Surgical Journal.

Vol. IX.] NEW-ORLEANS, JANUARY 1, 1853. [No. 4.

Before these lines shall have been read, another year, with its hopes, its an-
ticipations and its dreaded realities, will have come upon us, pressing us on-
ward towards that future, which many who are now active and full of promise,
shall never realize. In looking back upon the events and the trials of the year
which has just closed, let us gather wisdom and learn patience, and then go
forth to meet the future, thus enlightened from the past, with that calm heroism
and firm determination to grapple with the world as we find it, and strive to add
wisdom to virtue, and thus merit, if we cannot obtain, the approbation of the
wise and the just. To the Physician, close observation, deep reflection and
a patient waiting upon nature, can alone impart wisdom and enable him to dis-
charge the high and solemn duties appertaining to his mission^ To assist him
in these studies — to suggest matter for reflection, and to lay before him the
thoughts, the experience and the reflections of others, will be our duty, as it
shall be our pleasure, as a journalist. In striving to do this, we invoke the aid
of the medical profession throughout the South-west ; we turn with confidence
to our confreres for kindness and encouragement, — for that indulgence which
can alone inspire confidence in ourself, and enable us to do justice to the cause
which we have espoused.

We can only promise diligence in collecting and collating the most recent and
reliable medical intelligence, with an eye directed exclusively to the interests
and wants of our reading subscribers ; and if we fail to please all, we shall not
feel discouraged, but continue our labor with a singleness of purpose which
should secure us at least the respect and confidence of those who may not
sanction our course.

HEALTH, MORTALITY, &c.

We have but little to remark under this head ; the health of the city hag
steadily improved since our last publication up to date; and if we regard the
immense number of strangers now in our city, the mortality will be found low
almost beyond precedent. Added to Which, we have almost daily thousands of
immigrants flocking to our shores, in search of anew home, and yet we have
escaped, thus far, in a great measure, the ravages of ship or typhoid fever. This
can only be explained from the fact, we believe, well attested, that the immi-
grants this season comprise a better class of subjects than usual, — are better
supplied with the requisites for a long voyage, and consequently reach our
levee comparatively free from disease.

Our permanent population, natives and those fully acclimated, have been
exempt from every species of disease ; it has only been the inconsiderate— the
stranger and the dissipated among us, who have experienced the heavy hand
of affliction, sickness and death.

Below we append our usual weekly mortality.

554

The New-Orleans Medical and Surgical Journal.

DEATHS IN THE CITY OF NEW ORLEANS,

For the 9 weeks ending Dec. ]8lh, 1852.

1852

Cholera.

Fevers.

T7 T7T„

Y. rev.

1 otru.

Oct. 23d,

204

" 30th,

246

i\ov. otn,

OQ
Zo

JiOO

" 13th,

253

" 20th,

208

" 27th,

187

Dec. 4th

174

" 11th,

136

" 18th,

145

Total,

247

517

289

1786

Of this number 546 were under 10 years of age, and 224 colored.

For the nine weeks ending December 18th, the deaths average a little less
than 200 per week, from all diseases ; whereas those chargeable to Cholera and -
Yellow Fever were nearly equal. About one-third of the deaths were caused
by the various fevers ; and deducting those produced by accident, violence, etc.,
we may fairly conclude that at least one-half fell victims to some form of fe-
brile disease.

Cholera, as will be seen, claims its number of victims, although but little pre-
disposition to- the disease seems to exist in the city at this time.

The Yellow Fever, which was confined almost exclusively to the Charity
Hospital throughout the entire season, has disappeared; and we have now only
some diarrhoea, dysentery, typhoid fever* a few cases of pneumonia, and ca-
tarrhal affections. For several weeks past half the community has been
afflicted with catarrhal disease, attended with violent sneezing, hoarseness,
headache, and sometimes troublesome cough, accompanied with more or less
fever and great soreness throughout the chest. The cause seems to be atmos-
pheric, and no precaution could guard us against the disease. It showed but
little disposition to terminate in actual bronchitis, pneumonitis, or other serious
pulmonary diseases. All ages and colors were alike sufferers by this catarrh :
it usually persisted for two or three weeks in despite of the mildness of the
weather and the most careful nursing. At present it seems declining, and we
hope ere long it will entirely disappear. We do not know that it has proved
fatal in a single case. The city is otherwise perfectly healthy, and the wea-
ther as mild as spring.

Editorial. — City Intelligence.

555

QUININE AND OPIUM IN THE COLD STAGE OF PAROXYSMAL

FEVERS,

We have long thought it a desideratum in practice to find out some mode of
treatment by which the Practitioner may be enabled, when summoned to a
case of remittent fever, during the cold stage, to cut short the paroxysm —
to extinguish the intense febrile reaction, which usually succeeds the cold stage
of our summer and autumnal diseases. When called upon to visit a patient,
and we find him shivering with a chill — with blue lips and fingers — goose-
flesh, shrunken surface— quick, small, feeble pulse — more or less nausea —
great thirst — and in a word, laboring under the usual distressing symptoms of
the cold stage of fever, we usually content ourselves with warm foot-baths,
tepid drinks, etc ; but these domestic remedies serve only to hasten and aug-
ment the reaction ; they do not even abridge the febrile paroxysm which must
succeed the chill.

We are about to recommend measures which will meet the indications so
much desired in these cases, such as we have frequently tested in hospital, and
sometimes in private practice. Macintosh practised blood-letting in the cold
stage of fever ; but if this treatment proved beneficial in some cases, it opera-
ted injuriously in others ; and thus, by common consent, venesection in the
cold stage of fever, has been abandoned in the United States, as far as we
know.

Full doses of quinine and opium, given in the midst of the cold or shivering
stage of fever, will be found both safe and efficacious in a large majority of
cases. It puts a stop to the cold or chilly stage, increases the fulness, whilst
it diminishes the frequency of the pulse, allays, as by enchantment, the violent
neuralgic pains with which the head, back, limbs, etc., of the patient are tor-
tured, equalizes the circulation, promotes free perspiration, and rarely fails to
extinguish the intense febrile reaction, which, without the interposit ion of our
art, rarely fails to succeed the cold stage of our autumnal fevers. Opium and
quinine, thus administered, seem to restrain the violent action of the heart and
arteries, the former of which is curbed, so to speak, by the combination, and
held within its normal force and frequency. The patient passes at once from
the chill or chilly, into the sweating stage — characterized by a full, soft and
regular pulse, a warm, moist and relaxed surface, absence of thirst, headache,
restlessness, and the usual concomitants of intense febricity. He exchanges
great suffering, pains and uneasiness, for sweet and refreshing slumbers, for the
most part, from which he awakes at the end of a few hours, perfectly delighted
with himself and his Physician.

By this treatment we arrest the paroxysm more certainly than if we had ad-
ministered the quinine during the apyrexia; the series of morbid phenomena by
which a paroxysm of intermittent fever is characterised, is broken up ; and the
quinine and opium appear to arrest the disease definitively, by extinguishing
the germ of morbid action. The dose in the instances recommended should be

556 The New-Orleans Medical and Surgical Journal,

from 20 to 25 grains of the sulphate of quinine, and from 2 to 4 grains of
opium, in combination ; it may be repeated in severe cases, but in diminished
doses, after the first three or four hours.

Quinine and opium, given at the moment advised, are less likely to disturb the
encephalon than might be suspected by those who have never ventured to try it
in the cold stage of fever, to adopt a misnomer. Treated after the method
above recommended, the paroxysm is broken up, and will rarely recur the se-
cond time, although we may withhold the further use of the remedies. Under
our plan, convalescence becomes speedily established, the patient rapidly reco-
vering his appetite and strength. Many, and we include ourselves, venture to
administer the quinine and opium during the height of the febrile excitement,
with the most beneficial effects ; but it must strike any reflecting mind, that
if opium and quinine, given during the stage of exacerbation, exercises a se-
dative influence over the heart and arteries, how much more rational and easy
to keep down such febrile excitement by interposing our remedies before all the
links in the chain of morbid causes which constitute a .febrile paroxysm, shall
become firmly united I

DEATH FROM ASPHYXIA,

-Caused hy the accidental introduction of an Orange Seed into the Larynx.

REPORTED BT T. O. MEUX, M. D. , NEW ORLEANS.

The fatal termination of the case reported below, should induce us to watch
such patients with assiduous care. This little patient was seen by Dr. Stone,
when he was comparatively easy and free from all alarming symptoms; but
the danger of suffocation recurred in paroxysms, and in one of these attacks
he expired before medical aid could be obtained. We give the details of the
case in the language of Dr. Meux.

On the 1 0th instant I was called upon to visit Frasier, a sprightly

boy of six years old, boarding at Mrs. Carney's boarding house, Magazine
street, who was said to be threatened with suffocation from having, as was be-
lieved, got an orange seed into the windpipe, while eating an orange, some five
or six days previous, after which there was a constant embarrassment of respi-
ration, and on one or two occasions threated suffocation.

Upon my arrival I found the patient partially relieved of the symptoms of
suffocation ; yet the respiration continued of a very distressing character, and
upon learning the state of the case, I immediately proposed the aid of a Sur-
geon, and suggested Dr. Stone should be instantly called. Upon the Doctor's
arrival and examination of the child, and after hearing a history of the case,
he proposed the administration of an anodyne for the night, alleging, in reply
to the suggestion of the operation of tracheotomy, that it was a grave opera-
tion, and that we might not succeed in finding the offending irritant — promis-
ing to see the case the succeeding morning.

Editorial.' — City Intelligence,

557

I heard nothing more of the case until about one o'clock on the 12th, when
I was again summoned in haste to see the little sufferer ; upon my arrival the
child was a corpse; he had expired in a paroxysm of suffocation, occasioned
by the orange seed being forced into the glottis.

The mother of the child and other relations were on their way to California
to join his father, who had preceded them, being anxious to satisfy their minds
as to the cause of death, insisted on a post mortem examination, which I made
in company with my young friend, Dr. Reynolds, and as was anticipated, found
the orange seed so firmly impacted in the glottis, as wholly to preclude the
passage of air.

New Orleans, Dec 17, 1852.

ABSTRACT OF DISCUSSION ON TYPHOID FEVER,

At the sitting of Ike Physico- Medical Society of the 20ih November, 1852.

Dr, Stone mentioned having of late seen on some of the plantations in the
rieighborhood a number of cases of Typhoid Fever, This complaint, he re-
marked, had become of late years more prevalent in the South. The disease,
he said, had no special pathology. It seemed to run its course without much
interference being required. The most indeed needed was good nursing. He
had seen and heard of different modes of treating the negroes on the planta-
tions in the South affected with this complaint. Those who had tried bleeding
were compelled to abandon it when they found they were loosing all their pa-
tients. Some had used quinine ; and several of these also abandoned it after-
wards, not finding it to suit the purpose. Those who had been treated with
Sarge doses of this medicine, with the view of breaking up the fever, he found
from all he could learn, generally got worse. While those who had got some
gentle diaphoretic medicine, such as liquor ammonias acetatis, and who were
otherwise judiciously nursed, rarely failed to do well. Even very little purga-
tive medicine in these cases frequently produced injury of the intestines. His
conviction therefore was, as above stated, that patients, especially negroes,
who had been treated with most vigor did worst; and that on the plantations
where least had been done, the disease was generally got over after a period
of from ten to twelve days of sickness.

Dr. Fenner, who followed, went at some length into the subject of Typhoid
Fever, and fevers generally. These he regarded as but modifications of one
another; the difference depending upon circumstances that prevail at the par-
ticular period and place where these show themselves, and not on a difference
of cause, as is generally believed. They all, he held, had their origin in one
and the same cause, and this, whatever it be, was found on experience to be
best combatted by the exhibition of large doses of quinine ; which, if exhibited
with a little opium, rarely fails to cut one and all of them short ; and this was
as much the case in that form where the fever was continued, as in any of the

658 7%e New-Orleans Medical and Surgical Journal.

other forms where the fever was intermittent or remittent, or yellow feven in
each of which this treatment was acknowledged to be of so much service. In
reference to what had been said of those who had tried this particular treat-
ment in Typhoid Fever and without benefit, he said it would be found that
they had been administering it usually in too small doses at a time. To give
thirty-six grains m separate small doses In the twenty-four hours, produces
altogether a different effect upon the disease to that of giving- the same at once,
as he recommended it should. He had had an opportunity now of testing this
method in several cases of Typhoid Fever ; and in all the cases but one of
these held out beyond the fourth day. The most of them commenced with a
distinct chill, which then passed into continued fever. He is strongly convin-
ced, that if from twenty to twenty -five grains of quinine be given at the outset
of typhoid fever, it will cut it short; and mentioned in support of his own ex-
perience those of Dr. Dundas of Liverpool, and Mr- McEvers in Ireland, both
of whom had published the results of this treatment on the worst forms of Ty-
phus fever in these parts of the world, and as they testified, with marked ad-
vantage ; such as indeed the usual mode of treatment could in no way com-
pare with. The subject, he remarked, was now commanding attention, and
something further might soon be expected from those who here and elsewhere
have taken ft up.

Dr. Stone replied, that his observations had compelled him to differ widely
from Br.Fenner, both as to the origin and treatment of Typhoid Fever; and he
also differed from him when he thought but little good was to be derived from
studying the pathology of the different diseases he had been referring to. The
complications of Typhoid Fever, such as the inflammation of the glands, when
that occurred either at the outset, or as the result of the disease, require a par-
ticular kind of treatment different from that which is required in other kinds of
fevers where no such complications are met with. There is one thing he
had noticed in regard to giving quinine in Typhoid fever, and which may in
some measure account for any benefit that might be supposed to arise from that
mode of treatment, — the patients are otherwise usually left alone and not made
to have too much of purgatives and emetics ; and perhaps the former is less
injurious here than these latter, injudiciously administered as they frequently
are in these cases. When cases, he said, commenced with intermittents, it
would be all well enough to give quinine ; but in those cases that do not thus
commence, it is not as beneficial ; and this particular fever, which commences
and goes on gradually without these intermissions, could not be broken up by
this or any other treatment he knew of. The most that should be attempted
was to watch the symptoms, and by proper medical treatment and nursing,
mitigate these till it ran its course.

Dr. Fenner wished it understood, that he did not in his remarks in any way
wish to under-estimate the value of pathological distinctions in this disease ;
but he was satisfied that many of the changes which were produced in the
organs of the body were the result of the disease and not the cause, and were
altogether secondary in their occurrence. He believed the fevers he
had been referring to had their origin in the system, which was deranged,

Editorial. — City Intelligence.

559

and that this, when not cut short, may lead to all the mischiefs found in the
abdomen and other parts after death. His object was to have more attention
paid to the cutting- of them short, as he believed could be done, and there would
then be less occasion for discriminating the nicer pathological changes than
now. The most of fevers commenced with a chill, and there was usually a
recurrence of that. This was more or less true of what was called continued
fever ; and if what Dr. Stone had said regarding the indication for quinine be
correct, he did not see how, even on theoretical grounds, he should reject and
condemn it in this complaint as he did.

Dr. Hunt was surprised that Dr. Fenner should say that all fevers are the
same in their character, and that they result from the same cause. But it would
be noticed that all the cases he had referred to had commenced, according to
his own showing, with repeated chills; hence the use of quinine in such.
There are, he said, distinct classes of fever admitted by all authors of repute ;
while the gentleman says they all originate in the same cause, and hence the
same kind of treatment will suit in each. Sir, he continued, I have heard of
barber's chair that fitted all persons, but not of all patients being cured by one
mode of treatment. The lancet often is necessary when hyperamia exists ;
often, too, necessary before the Physician dares to introduce quinine into the
system; and throughout, according to the condition, so must the case be
treated. The study of the pathological condition of the system is the true
mode of proceeding. To do otherwise sets at defiance every principle of sci-
entific physiology. Dr. Hunt made several other scientific remarks condem-
natory of the doctrine held by Dr. Fenner, and was followed by Dr. Stone,
(who in answer to some interrogatories put by Dr. Fenner was again called
up. repeated that he regarded Typhoid Fever as a specific disease; as specific
as any of the eruptive fevers are; and, that like these, when it once is set fairly
in, it runs its course. Different efforts, he knew, had from time to time been
made to cut it short, especially in the North, but he knew as well that these
had failed. It was not, he said, unreasonable to suppose, that in the South a
particular miasma or poison may prevail, and produce a more or less distinct
disease, and that this is different from the genuine Irish form which we some-
times see imported. This new disease first sprung up in some of the older
sections of the country, and has been spreading of late years in the newer
sections also. When it attacks a patient, it appears to begin as a specific dis-
ease of the system, and in its progress, its injurious influence appears to be
determined more especially to the mucous membrane of the intestines, and
with as much certainty as the poison which produces the pustules of small pox
is to the surface of the body.

COMPLIMENTARY TO DR. MACGIBBON.
At a meeting of the Physico-Medical Society, held December 18th, 1852, a
beautiful and costly case of Obstetrical Instruments was unanimously voted
Dr. Margibbon, the Recording Secretary of the Society, as a testimonial of
good feeling for the able and satisfactory manner in which he had performed
the duties of Recording Secretary for the last three years.

560 2 Vie New-Orleans Medical and Surgical Journal

HEALTH OF THE COUNTRY.

Typhoid Fever— Abortive treatment thereof by Quinine— Efficacy of the Cold
Douche in Congestive Fever, illustrated by cases, in a letter to the Editor.

BY A. PATTON, M. D., MISS.

The summer is past— the Physician's harvest is ended, and now is a favor-
able time to review our labors of the past season ; and if our experience, the
Southern Physician's best text book, is found to be in the least degree valua-
ble, we should obey the Scripture injunction, and not " hide our light under a
bushel," but give it to the profession through some of our excellent Southern
Medical Journals, so that all may learn from each others observation.

Our country and neighborhood have been visited by an unusual amount of
disease during this past summer and fall ; much more than has occurred any
season since 1844 ; but I am glad to be able to state that the mortality has been
far less in this vicinity than occurred during that year. The fatal cases that
year were generally from bilious remittent and congestive fevers ; this year
the same character of diseases have prevailed to a considerable extent, and in
my practice with but one fatal case, and that not seen until there was profound
congestion of the brain and lungs. Our remittent fevers yield more readily to
a proper treatment ; which consisted of first, a small purgative dose of calo-
mel and blue mass or rhubarb, followed by an aperient, if necessary. We
avoided active purgation in all cases. Infusion of serpentaria and spirits nitre
were used as a diaphoretic, and as soon as a slight remission occurred, we gave
to an adult from 20 to 30 grains of quinine, with a quarter or half grain of
morphine, repeating the quinine every three or four hours, until the fever sub-
sided ; then kept up medium doses of quinine for a few days, to complete the
cure. This treatment never failed in any case within my observation. Excel-
lent effects were derived from ice taken into the stomach in lumps ; also spon-
ging the surface with cold water when the skin was dry and hot. I have
treated 13 cases of true Typhoid Fever during the season, with one fatal ter-
mination. The disease exhibited the usual phenomena in such cases, and it is
unnecessary for me to refer to symptoms, except to state that considerable
tenderness on pressure over the right iliac region was experienced in every
case, with a gurgling sound. The disease ran its course in from 15 to 42
days, with a very tedious convalescence ; these patients retained their strength
astonishingly, though there was great emaciation. I adopted the following
treatment:

During the first four days ail the abortive means advised by Dr. Fenner and
others, were, I conceive, most faithfully employed ; quinine was given in doses
from 20 to 40 grains, repeated occasionally according to effects. I gave the
veratrumtviride a trial, and although it certainly reduced the frequency of the
pulse, and greatly reduced the heaiCs action, yet it failed to arrest the disease ;
still I am inclined to believe that the remedy will be found useful in some
diseases. In this first stage I gave one or two small doses of calomel, fol-
lowed by aperients, if necessary, though I found it important to watch the
effects of purgatives, and after the first few days relied on charcoal and mag-

Editorial. — City Intelligence.

561

nesia to open the bowels, assisted by enemata. After giving the abortive treat-
ment a fair trial, the disease still progressing without any beneficial change
being effected, I then calmly informed my patient that he labored under a very
peculiar fever, which we term typhoid, and that it would run its course in spite
of all the remedial measures which could be used, perhaps confining him to the
bed ]5 days, or more likely 21, and probably 42 days. This to an industrious
and energetic man was a very bitter dose, but he was compelled to swallow it.
I watched bAm by day and prayed for him by night, and gave medicine in smal]
doses, and after a long time, all my patients, save one, recovered. But to
continue with the treatment — I allowed ice, and as nutritious a diet as they
would take; and to relieve the intestinal disease, I gave in every case small
doses of oil of turpentine, which I regard as being the most important and
valuable remedy used in these cases ; it seemed to exert a most happy effect,
and unlike its operation when given in some other diseases, it never produced
any bad effects.

I therefore express my deep conviction, that oil of turpentine in doses of from
5 to 15 drops, in mucilage, repeated every three or four hours, is one of the
most valuable, if not the very best remedy that can be used in Typhoid Fever;
and although it does not " break the fever," yet I think it prevents the patient
from dying.

I also invariably apply a blister to the abdomen in the advanced stage, and
if it gets well too soon, re-apply it. As an aperient, I prefer charcoal with
magnesia, assisted, if necessary, by enemata. I commence supporting the
strength very early by stimulants, if they are not contra-indicated. If there
is much stupor, I prefer carbonate of ammonia, and indeed I usually give it
the preference over all other stimulants in this disease. If serious local in-
flammations occur, which often happens, I control them by the same means
which I would resort to if no typhoid fever existed, with some slight modifica-
tions.

I shall now proceed to give some account of the congestive cases met with
this season, and the mode of treatment adopted. It is, however, unnecessary
to minutely describe these cases, as the profession in the South are fully ac-
quainted with all the phenomena usual in such diseases. I will state that I
have seen five cases during the summer, four of which presented all the
alarming symptoms always accompanying the worst form of the disease.
Three of these four cases were promptly relieved by a treatment, which, al-
though not new, yet I am certain that many Physicians entirely neglect the
remedy, and allow their patients to die without resorting to the treatment.
I allude to the cold douche as a means of producing reaction in congestion.
We find nothing in the books in regard to the remedy that would warrant us
in attributing to it the great value which it undoubtedly possesses. I am now
fully warranted by actual experience in affirming, that it is the most certain
and safe remedy in the diseased conditions alluded to, known to the profession ;
and I am fully sustained in this opinion by several distinguished gentlemen,
who have treated on the subject through medical journals — I refer to Profes-
sors Patton and Barbour of St. Louis, and Doctors Fearn of Alabama and
Richmond of Indianapolis, and others.

56*2 The New-Orleans Medical and Surgical Journal.

As a remedy for poisoning with opium, its value is, I believe, universally
acknowledged. I have myself employed it in three cases of this kind with
the most happy effect. But it is its truly beneficial effects in Congestive Fe-
ver to which I wish to direct the attention of the profession at this time. I
have said that it is the best remedy in such cases known to the world. I say
it because I have carefully compared the effects of other remedies with the
effects of cold water. I have every season during the last twelve years treated
more or less Congestive Fever, and it is pretty certain that I have had an op-
portunity of observing the effects of all the best remedies (fori take and read
the Medical Journals) in this disease ; and after this careful comparison I am
prepared to reiterate the opinion expressed above. For even in the cases in
which I have tried the cold water, I had fully and fairly tried the other reme-
dies, and it was after they had failed — utterly failed to cause reaction and the
patients were rapidly sinking — exhibiting all the marks of approaching death
— parents weeping in despair — my hope almost gone — I say it was with all
these growing circumstances surrounding the cases, that this most potent re-
medy was resorted to, and with what signal and astonishing success at least
three grateful families in this community can testify. In two of the cases
referred to I had the valuable assistance of my partner, (Dr. W. C. Payne)
who fully concurs with me in all that I have said of the value of cold water in
Congestive Fever.

It is not my intention to condemn the use of any other means to aid the
cold water ; on the contrary, I would earnestly advise the administration of
large doses of quinine, either by the mouth or injection, both before and after
the application of the water ; also hot bricks to the extremities, which I deem
sufficient in most cases. Many suppose that there is some danger to be ap-
prehended from the remedy ; I am satisfied that there is no danger in it ; I have
seen no bad effects from it of any kind whatever, and it is certainly much
more pleasant to the patient than the hot irritating application s usually re-
sorted to in these cases.

And now permit me, as a mparis of more fully illustrating the subject, to
report a most interesting case, which occurred a few days since. On the 28th
of November T was called in haste to see Henry D., aged 8 years. When I
reached the patient, I found him far advanced in a most alarming congestive
chill, his extremities were cold as marble, no pulse perceptible at the wrists,
heart's impulse very feeble, tongue pale and cold, face and hands a livid
paleness, features shrunken, respiration like a succession of deep, irregular
sighs, stomach irritable — in short, the symptoms were all most unfavorable. I
at once commenced a vigorous application of the usual remedies, and for a
short time with some benefit ; but soon their effect ceased, and the patient
began rapidly to sink, which continued in spite of all my efforts. I had tried
the boasted remedies usual in such cases, (except bleeding, and common sense
would have taught even Mackintosh that that remedy was inadmissible) and all
had failed ; the family were in despair ; death appeared to have marked the
little sufferer for its victim ; but in this dreadful crisis I prepared cold wa-

Editorial. ^-City Intelligence.

563

ter— no objections being made by the parents. I had the almost dying child
divested of all his clothing and laid on the floor, face down, and poured from a
large pitcher, at a height of several feet, two buckets full of cold water on the
back ; applying the water first to the occiput, then proceeding down the spine
to its termination ; then wiping him perfectly dry, I had him well wrapped in
blankets and covered up warm in the bed, with bottles of hot water to the feet,
allowing him to remain perfectly quiet ; and in one hour and twenty minutes
from the time the water was poured on him, full and complete reaction had
taken place, the extremities were warm, pulse good, respiration natural, and in
short the child was saved — saved, too, by cold water, when any other remedy
would have been utterly powerless to do so.

I must close my long letter without noticing any other diseases which have
prevailed here ; though there has been much dysentery, and some fatal cases.

DANIEL DRAKE, M. D.

Physico-Medical Society. — Extract from the Journal of the proceedings —
meeting of November 20, 1852. The following rosolutions, offered by Prof.
J. L. Riddell, and seconded by Dr. E. D. Fenner, were passed.

Resolved, That this Society having learned of the decease at Cincinnati on
the 5th instant, of Daniel Drake, the eminent teacher of medicine and medical
author, will record in its archives a memento of the profound regret with
which its members greet the sad intelligence.

Resolved, That the indomitable industry and perseverance, the good habits
and the many virtues of Daniel Drake, have contributed to the fair name of
our profession, and are worthy of remembrance and imitation.

The above is a just tribute to the memory of one who had labored for years
to advance the science of medicine in the Valley of the Mississippi — of one
who had, by his writings and teachings, inspired the profession with something
like self-confidence, and set an example of toil and devotion to the study of dis-
ease and climate worthy of emulation.

Dr. Drake died, we believe, before he had finished his second volume on the
Peculiar Diseases of the Mississippi Valley.

PHYSICO-MEDICAL SOCIETY OF NEW ORLEANS.

At a recent meeting of this Society, Dr. A. F. Axson was chosen President
for the ensuing year. This is at once a well-deserved and a graceful compli-
ment to the talents and parliamentary accomplishments of Dr. Axson, who, we
feel satisfied, will discharge the duties of his new office with dignity and im-
partiality. We congratulate our cotemporary of the " Register" on the high
and honorable position to which his talents have elevated him.

564

The New-Orleans Medical and Surgical Journal,

LOUISIANA STATE MEDICAL SOCIETY.

The following named gentlemen have been appointed Chairmen of the vari-
ous Standing Committees of the Louisiana State Medical Society, and are ex-
pected to report on the topics entrusted to the several committees during the
annual session of the Society, to be held in March, 1853, in the Hall of the
Medical College in this city.

1. Medical Education and the License Law — J. S. McFarlane,M. D.

2. Anatomy, Surgery, and Surgical Anatomy— B. H. Moss, M. D.

3. Physiology and Pathology— A. W. Ely, M. D.

4. Midwifery and the Diseases of Women and Children — N. B. Benedict,
M. D.

5. Practical Medicine— T. O. Meux, M. D.

6. General Therapeutics, Materia Medica and Pharmacy — Howard Smith,
M. D.

7. Meteorology and Hygiene of the State and its Vital Statistics — A. Hes-
ter, M. D.

8. Diseases peculiar to Negroes and to a Southern Climate — M. A. Mc-
Leod, M. D.

9. Adulteration of Medicines and the sale of Drugs and Nostrums — G- T.
Browning, M. D.

10. Botany and Natural History — Josiah Hale, M. D.

CORRECTION.

Montgomery, Ala., Dec. 5, 1852.

A, Hester, M. D.

Dear Sir — In the twentieth line from the top, on the second page of my
article " On the Use of Quinine in Continued Fever," published in the July
number for 1852 of your Journal, the word " exacerbative," through a typo-
graphical error, is printed " acerbative." At the time the Journal was received
and read, I did not deem it necessary to trouble you with a request to notice
the erratum, for the reason that I supposed that the character of the error was
so obvious and apparent, as to be at once recognizable to all who might read the
paper. I have recently, however, been admonished, that such is not the case,
and you will therefore confer a favor by making the correction.

Very respectfully,

WM. M„ BOLING.

L'UNION MEDICALE DE LA LOUISIANE.
We regret to learn from Dr. Delery, one of the editors of this spirited and
industrious monthly journal, that the U Union Medicate will cease to be pub-
lished at the close of the first volume. Want of punctuality in the payment of
subscriptions is assigned as the cause of this suspension,

Editorial* — City Intelligence.

565

TYPHOID FEVER.

A. Hester, M. D.

Dear Doctor — I see Dr. Wilburn wishes a list of medical names as to the
identity and non-identity of Typhoid Fever South. By reference to Nelson's
Lancet, you can find my opinion as to the character, causation, etc., of the dis-
ease. We have it here in abundance ; quinine is death to it. I have made
several autopsies lately, and their results, etc., are all in press and will be given
to the profession soon.

That it is a disease sui generis, caused to some extent by the extravagant use
of quinine, but generally of . malarial origin, requiring better attention and less
medicine than any febrile affection in the South, I am fully and strongly
convinced.

Yours, truly,

H. A. RAMSAY.

Thompson, Ga., Nov. 8, 1852.

LITHOTOMY— BILATERAL OPERATION.

BY CHAS. DELERY, M. D., NEW ORLEANS.

This operation was performed the 23d November, 1852, on Alex. Lesseps, set. 56,
who had been laboring under calculus of the bladder for at least one year. About 22
days after the operation Mr. L. returned to his usual avocations. During the opera-
tion, a little over five ounces of chloroform were consumed, without any accident.
The stone weighed 8 scruples, and is flat and hard. A few years ago Dr. Delery
performed, with complete success, a similar operation on a child 12 months old. This
case has already been reported in one of our back numbers.

TO SUBSCRIBERS.
To delay longer to call the attention of our subscribers to their unsettled
accounts, would be to do injustice to our own interest and inflict a wrong upon
those of them who have always promptly paid up their dues. Many — very
many have received the Journal for two and more years, and because we can-
not call upon them in person and enforce our claims, have neglected to remit
us a single year's subscription. We trust few are so poor that they cannot
pay the little sums due us for furnishing the Journal at our own expense. Will
they suffer this state of things to continue ! Will they receive the Journal,
and neglect, through carelessness, to pay for it ? We cannot afford to employ
agents to call upon those who are in arrears to us ; this would be annoying to
them and ruinous to us.

VACCINE VIRUS.
The Editor will hereafter keep a supply of Vaccine Virus.

566 The New-Orleans Medical and Surgical Journal.

REPORT OF THE CHARITY HOSPITAL,
(NEW-ORLEANS,)
For August, September, October and November, 1852.

We are indebted to the politeness of E. Porter, Asst. Clerk of the
Charity Hospital, for the following table.

Admissions -
Do. - -

Discharges -
Do. - -

Deaths - -
Do. - -

Births - -
Do. - -
Still-born -

Num. remain.

sex.

Males
Females

AUG.

1288
507

1795

1163
444

■1607

101

SEPT.

1303
417

■1720

1141

420

■1561

155

13
7
4

127

24
807

8
2

191

20
871

OCT.

1412

395

•1807

1150
377

•1527

274
39

5
0

31;

893

1356
396

1003

326

■1752

1329

270
54

324

860

ABSTRACT OF A METEOROLOGICAL JOURNAL FOR 1852.

BY D. T. LILLIE & Co., at the City of New Orleans.
Latitude, 29 deg. 57 min. ; Longitude, 90 deg. 07 min. West of Greenwich.

WEEKLY-

THERMOMETER.

BAROMETER.

COURSE

FORCE
OF THE

Quantity

OF THE

WIND,
Ratio

RAIN

1853.

Max.

Min.

Range.

Max.

Min.

Range.

WIND.

1 to 10.

Inches.

Oct. 28

84 .0

65 .0

19 0

30.10

29 .85

0. 25

SE.

3 10

5.400

Nov. 4

76 .5

57.0

19 5.

30.12

29 .95

0. 17

2.60

0.495

" 11

81.0

54 .0

27.0

30 .30

29 .90

0.40

NE.

2.40

1.415

" 18

69.0

43 .0

26 .0

30 .3<»

29 .70

0. 60

2.15

1 930

« 25

79 .5

45 .0

34 .5

30 .25

29.60

0.65

2.44

4.805

Dec. 2

68 .0

44 .0

24.0

30 .37

29 .90

0. 47

NE.

2.28

2.245

73 .0

45 .0

28 .0

30 .10

29 .90

0.20

2.60

0.740

" 16

74.0

44 .0

30 .0

30 .15

30. 00

0. 15

2.50

2 670

The Thermometer used for these observations is a self-registering one, placed ia
a fair exposure. Regular hours of observation : 8 A. M., 2 . M., and 8 . M.

ADVERTISEMENTS.

MEDICAL JOURNALS,

PUBLISHED BY RICHARD AND GEORGE S. WOOD,

No. 261, Pearl street, New York.

The British and Foreign Medico-C irurgical Review, and Journal of Prac-
tical Medicine. — Published Quarterly, at $3 per annum in advance.

The Annalist : a Record of Practical Medecine in the city of New York.
Published semi-monthly. — Price, $? per annum in advance.

DRUGGISTS,

No. 75 CAMP STREET,

NEW ORLEANS

Practical experience, for upwards of twenty -five years, has convinced us of the im-
portance of genuine Drugs and their preparations, when required at the bed-side.

SPINQ-ABDGMINAL SUPPORTER.

This Instrument, as its name suggests, is designed as a remedy for various
complaints, dependent on a weakened and relaxed state of the Spinal and Ab-
dominal muscles. The vast number of cases of diseases, depending prima-
rily on such weaknesses, is well known to the medical profession, to which an
instrument that would correct these evils in a satisfactory manner, and yet be
free from other disadvantages, has long been a desideratum.

SHERMAN, Agent for the South, 70 St. Charles street.

FRESH VACCINE VIRUS.

Dr. E. D. FENNER, (No. 5 Carondalet street,) will continue to supply the Pro-
fession and community with fresh and genuine Vaccine Matter. Orders by letter
promptly attended to.

New Orleans, November 1st, 1852.

WORKS

®F THE SfitlHM S®@iiT¥*

(LONDON.)

The undersigned having received the appointment of " Local Secretary" of
this Society for the Southern States, would respectfully invite attention to the
valuable Standard Works which it publishes each year, and furnishes to sub-
scribers, at extremely low rales. The annual subscription is only^e dollars,
for which, usually three, but sometimes four, valuable volumes of the best med-
ical works, are furnished. The works of several of the last years are still to
be had.

E. D. FENNER, M. D., Local Sec'y Sydenham Society,
Dec. 16, 1851. No. 5, Carondelet street.

THE NEW-ORLEANS

MEDICAL AND SUEGICAL JOURNAL.

MARCH, 18 5 3.

ORIGINAL COMMUNICATIONS.

I. REPORT OF THE COMMITTEE ON MIDWIFERY AND THE

DISEASES OF WOMEN AND CHILDREN.

BY WM. P. HORT, M. D,, CHAIRMAN,

[Concluded.}

The last general remedial agent of which we shall speak is chloro-
form. When skilfully administered, this is an agent of almost incal-
culable value. The fear of pain prostrates the vital energies more
than the pain itself ; but when the two are conjoined, it would seem
that human nature must succumb. When females read, and are told
by those who have tested the remedy, that they can be rendered in-
sensible to all suffering during parturition, they are delivered from the
fear of pain, and this fact renders the system far more susceptible of
the influence of anaesthetic agents. Professor Boling of Alabama has
concentrated a mass of facts and opinions relative to the use of these
agents, which he has presented to the public in an able and interesting
article, published in the November number, 1851, of the New Orleans
Medical and Surgical Journal. We are there informed that Professor
Simpson of Edinburg, on the 19th January, 1847, first employed this
plan of producing insensibility in obstetrical practice, Pr. Keep of

568 The New-Orleans Medical and Surgical Journal.

Boston introduced its use in the same practice on the 7th April follow-
ing. The Professor then observes : " But about four years have elap.
sed since the announcement of the discovery, and yet, throughout the
civilized world, by the members of the Medical Profession very gener-
ally, whether in the refined and populous cities of Europe, and our
older States, or in the remote villages of our frontier settlements, the
importance of the discovery is admitted, and the remedy frequently re-
commended and used."

He again remarks : " No person who has ever been submitted to
the process of Etherization once, in parturition, that I have met with
or heard of, would be willing to pass through the same process again
without it."

There was a general opinion at one time, that this class of remedies
simply produced a partial insensibility to pain during a period of stupor
induced by the agent. This opinion is however at present rejected, as
both in surgical operations, and during parturition, the pain is in some
instances actually suppressed, without any sleep or stupor being indu-
ced, the patients being conscious all the time of what was going on, and
retaining a perfect recollection of every thing that occurred while un-
der the influence of the remedy. To produce this effect of relieving
the patient from pain, Letheon, a very pure Sulphuric Ether, was at
first employed, but it has yielded to Chloroform, which is considered a
safer and more effective, as well as a more agreeable agent. The ex-
treme severity of suffering which some women experience in parturi-
tion, renders almost invaluable the remedy in question. It should be
as pure as possible, and always administered with great caution by an
experienced practitioner. In a few instances, that may with propri-
ety be called exceptions to a general rule, we are informed that the
administration of Chloroform has either failed entirely to produce the
desired effect, or has terminated fatally. There is reason to believe
that these exceptions have been occasioned by an impure Anaesthetic?
or an unfavorable condition of the system, or the want of judgment in
the practitioner. Professor Boling quotes Dr. Channing, who states
that " up to the time of the publication of his work, in 1848, there had
not been reported a case in which, during Etherization in labor, any
untoward circumstance had occurred." Professor Boling further says
that "up to the present time (November, 1851) no death has been re-
ported as resulting from Etherization in obstetrical practice ; the few
that proved fatal occurring during or after surgical operations.

We cannot speak too highly of this remedy, which, while it calms
the mysterious fear and ever increasing anxiety of the woman, and

Dr. Hort's Report on Midwifery.

569

relieves her completely from physical suffering, does not impede in the
least the natural muscular dilatations, and the expulsive efforts which
nature requires in the hour of parturition. A most ridiculous objection
has been made to the use of Chloroform in parturition, because the
effect it produces of calming the fears and alleviating the pains of
labor is said to be at variance with Scripture. When Geologists and
Archaeologists were exhuming truths and facts long lost, if ever known
to the enquiring mind of the patient investigating philosopher, the
clergy took the alarm, and inveighed against this innovation, which
they termed skepticism. But error does, and ultimately ever will, suc-
cumb to truth. The geological developments and facts once so start-
ling to the superstitious fears of timid priests, are now used as evidence
to sustain the validity of the sacred volume. And just such is the case
in relation to the effects of Chloroform, of which we have been speak-
ing. In the 3d chapter and 16th verse of Genesis, we read as follows :
" Unto the woman he (that is, God,) said, I will greatly multiply thy
sorrow and thy conception ; in sorrow thou shalt bring forth children,"
&c. We remark that sorrow is spoken of twice in this passage, but
without any allusion whatever to pain. We therefore infer that sorrow
has reference to parental feeling wounded, and to love alienated, and to
affection crushed. Its meaning cannot be tortured so as to signify the
prediction of physical suffering. Admitting the truth of the Mosaic
history, we nowhere read of a change in the physical organization of
the woman. On the contrary, we have every reason to believe that
it was the same before as after the period of the alienation of the
Adamic race from Deity. What would be the pains of labor, which
are temporary and transient, to the inexpressible suffering of the mo-
ther who has had one of her sons murdered by a brother ! But passing
over this ancient record of Cain and Abel, let us for one moment think
of a mother's sufferings, anguish and dismay, who, year after year may
have to watch through wearisome days and nights, by the bedside of
beloved children, gradually wasting away under the fatal grasp of un-
relenting disease. Again, think of the mother's anxiety on account of
her children, should they pass through the perilous ordeal of infancy.
She knows the temptations to which they will be exposed, and she
shudders at the fate that may await them. It requires but little effort
of memory and imagination to complete this gloomy picture.

The physical pain then that a parturient female experiences, is not
the result of an absolute and universal decree of Deity ; but it is first
to be referred to climate, next to habits of life, and above all, to that so

570 The New-Orleans Medical and Surgical Journal.

called civilization, which enervates by luxurious living the physical, the
moral and the intellectual.

The influence of climate on the constitution and development of the
female, is known to every member of this Convention. In Persia
there are mothers at ten years of age, while in Lapland girls seldom
menstruate before they are twenty years of age, and no anxiety is felt
should the catamenia not be established before the twenty-fifth year.
Where the climate favors early development, the pains of parturition are
moderate and of short duration. With respect to the women of high
northern regions, we have no positive information ; but in its absence
we infer that parturition is more protracted and probably more painful,
without being attended with more than ordinary danger. Now, the
habits of life must be considered in connection with climate. In all
climates, those females who take the most exercise, either for pleasure
or profit, produce the most vigorous and healthy children with compara-
tively a very moderate share of physical suffering. All experienced Phy-
sicians know that the greatest danger, delay, and physical suffering, are
to be found in the walks of fashionable, luxurious life. It is a well
known fact, that while such persons give birth with difficulty and great
suffering to puny children, who are cut down, as the young buds and em-
bryo fruits by the relentless frosts, the children of the working classes
are robust, vigorous and healthy ; in short, we there see the physical
power which forms the bone and sinew of the body politic.

Amongst the Indians, it is a common custom for the women, when
aware of the approach of labor, to retire to some secreted spot, where,
aided alone by the God of Nature, through his natural laws, they are
safely delivered ; when they return to their homes to resume their ac-
customed duties.

The difference between the sufferings of negro women who work in
the open air, and of those who are brought up in the house, is re-
markable.

A young negro woman was seen by her owner, Dr. Meriwether, in
the State of Georgia, washing clothes at a spring about one mile from
home ; being pregnant and near her full time, he reprimanded the girl
for her imprudenee. Having spent the day with a friend, he found, on
his return in the evening, the same girl finishing her washing, having
in the meantime been delivered of her burthen. Feeling the pains of
labor, she walked home, was delivered of a healthy child, and in three
hours returned to the spring.

It is known to the Committee that a negro woman has been taken

Dr. Hour's Report on Midwifery.

571

in labor while working in the cotton field — she started for home, but
when about half way, she was delivered of the child ; in about an hour,
the women were returning at dinner time, when they relieved her, as
far as was necessary. She walked home with them as though nothing
had happened.

Instances equally remarkable amongst active, industrious white fe-
males in civilized life, might be cited ; but enough has deen said to
establish the point we had in view. If severe physical suffering, such
as is described by the French authors in strong language, had been de-
creed by Deity, it would be a law without exception ; no woman would
be exempt. But this is not the case, as a vast body of facts could be
concentrated to prove the contrary. It follows, therefore, that the sor-
row spoken of in the decree of Deity is moral rather than physical
suffering. From the latter thousands escape ; in the former, all parti-
cipate to a greater or less extent. When we speak of physical suffer-
ing, we speak comparatively ; we presume that parturition is necessa-
rily attended with some pain under all circumstances and amongst all
animals from the highest to the lowest, but the degree of suffering de-
pends entirely on circumstances. Some probably suffer no more than
men do in ordinary colic of short duration, while others have doomed
themselves to indescribable suffering. -

Deformity of the pelvis, which is productive of the most hopeless
misery, is seldom seen amongst the working classes, and is probably
not to be heard of in the experience and traditions of the Indians. We
admit, however, exceptions to every general rule. Amongst some of
the inferior species of the mammalia, we may meet with here and
there, scattered through long intervals of time, a case of malforma-
tion, which makes parturition the cause of death. Such cases, we
have reason to believe, are extremely rare. This deformity of pelvis is
almost invariably found in the hot-beds of civilization, where luxury,
dissipation and licentiousness riot in unlimited excess.

The practical inferences from these remarks will suggest themselves
to every member of the Faculty who may be present on this occasion.
A woman who is pregnant, should consider the whole affair, from its
inception to its termination, as a natural process, common to all ani-
mals. She should be active in attention to her duties, when in doors
or out of doors, disregarding temporary inconveniences and evanes-
cent pains. In eating, the instincts of nature may generally be trusted,
but the bowels should always be kept open and regular. Women
while pregnant will suffer more or less annoyance ; and some suffer

572 The New-Orleans Medical and Surgical Journal.

much more than others, while to a third class the inconvenience is so
slight as to give no cause for complaint. As a general rule, these
annoyances and inconveniences will be greater or less according to the
habits of the pregnant female in civilized life. Just as those persons
who resist sea sickness with moral firmness, are the soonest relieved,
so is it with pregnant women. Energy of character can accomplish
much here, as every where else. The woman who flies to the bed or
the sofa whenever she may experience nausea, or detect a nervous
irritation, or feel a muscular pang, may expect prolonged and increas-
ing suffering during gestation, and with gloomy apprehension look for-
ward to the hour of parturition. We have dwelt on this subject at the
risk of being deemed tedious; but the object of the Committee was
to establish an important fact — that the sorrow spoken of in the Bible
to which every mother is doomed, signifies moral and not physical suf-
fering. And that the degree of physical suffering is regulated en.
tirely by circumstances ; in short, that it is more a conditional than a
necessary evil.

The moral suffering, which, according to Scripture, is the conse-
quence of alienation from Deity, may also be greatly mitigated by the
patience and resignation which a pure religion inspires. Where the
physical, the moral and the intellectual are properly cherished and re-
gulated, a mother has comparatively little to fear of inconvenience du-
ring gestation, or of pain and peril in the hour of trial ; and commit-
ting her children to the care of Deity, with abiding confidence and re-
signation, her moral suffering becomes greatly alleviated, if not entirely
obviated.

THIRD PART.

We now proceed to the third department of our subject — the consider-
ation, or rather enumeration of the inconveniences or diseases peculiar
to» woman in the civilized state; such diseases being unknown, as a
general rule, amongst people who are not civilized, as Indians and ne-
groes. It is evident that in a discourse on this subject, condensation
is necessary, and that while we advert to prominent points, °J1 detail
must be avoided.

The first serious inconvenience that the pregnant woman may ex-
perience is, according to the best authorities, Displacements of the
Uterus. The causes may be summed up in a few words — the influ-
ence of the abdominal viscera, a distended bladder, protracted costive-
ness, etc., etc. Prolapsus, Retroversion, and various obliquities, are
included under the general term of Displacement of the Uterus. In

Dr. Hort's Report on Midwifery.

578

these cases, a nice discrimination, based upon an experience of the
symptoms peculiar to each kind of displacement, is very necessary, as
well as accurate anatomical knowledge, to enable the practitioner to
afford relief. Nausea and vomiting are excessively annoying to some
women about the time that the uterus emerges from the rim of the pelvis
— and in some instances this annoyance endures almost during the whole
time of gestation. For this disagreeable affection various agents have
been recommended and tried. We are of opinion that it is more pru-
dent to let nature alone. Nature, as a general rule, is fully competent
to carry on her own work, and if the Physician interferes with his nos-
trums, to assist nature, as it is said, ninety times out of one hundred, he
will probably do more harm than good.

The enlargement of the abdomen is much greater in some women
than in others. It may produce obstinate costiveness ; dropsical affec-
tions in various parts of the organs ; varicose veins of the lower extre-
mities, which produce great deformity, and often considerable pain.
In some cases there is no remedy, but time and patience; in others,
relief may be afforded by bandages properly applied to sustain the
uterus, and prevent its pressure on the bladder and rectum. Salivation
occasionally annoys a pregnant female ; how it is induced no one knows
— therefore, to relieve it, must be rather the result of chance, than
of art.

Various forms of deranged digestion sometimes prove very distress-
ing. There may be an alkaline condition requiring acids, or the gene-
ration of superabundant acidity demanding alkalies. Fluor Albus or
Leucorrhcea often torments pregnant women in civilized life. The
most simple remedies with reference to cleanliness should alone be
used during gestation. Cantharides, which so effectually controls this
disgusting disease, is altogether inadmissible in the case of a pregnant
woman.

Pruritus of the Pudendum may occasionally affect women who are
not pregnant, but it chiefly annoys the pregnant woman. Professor De-
wees has informed us that it can be relieved in twenty-four hours by the
use of a strong solution of borax in water. He says that the appear-
ance of the parts resembles the apthoe of children, which suggested to
his mind the use of borax. Probably the experience of many Physi-
cians present confirms this remark.

There is at one time a retention of urine, requiring the use of the
catheter ; and again a too frequent inclination to pass the urine, produ-
cing all the inconvenience of stranguary, without the pain. Supporting
bandages are the best remedies, as before observed.

574 The New-Orleans Medical and Surgical Journal.

The most formidable condition of things we have ever witnessed, is
when the female, a short time previous to the period of parturition, is
attacked with convulsions, which are sometimes so violent as to threaten
the immediate termination of life. Here, energy, patience, and a stern
determination are absolutely necessary. When the pressure of the
blood, in undue proportion, produces congestion in the vessels and si-
nuses of the brain, with frothing at the mouth, and a shuddering of the
whole muscular system, the peril is great. Although nervous irritation
is the primary cause of all the disturbance, it is now too late to calm
that irritation ; the brain must first be relieved, by opening the temporal
arteries — which being accomplished, we may then endeavor to calm
the agitation of the nervous centres. The best and safest remedy,
however, is the immediate delivery of the child ; and any thing that
can be accomplished by art, without an increase of danger to the mother
or to the child, should be promptly and boldly resorted to.

The death of a foetus in the uterus some days previous to parturition,
creates difficulty and delay. The fact is easily recognized. Instead of
lively motion pervading the uterus, there is sense of a dull, heavy
weight, bearing alternately on one or the other side. In this case, it is
of the first importance to keep the mother ignorant of the death of
her child. None but sensible, confidential persons should be al-
lowed to come near her, and every effort should be made, without the
appearance of effort, to inspire her with confidence and hope. The
practitioner must take care that the bowels and bladder are thoroughly
evacuated preparatory to the commencement of parturition, and there
is no case in which patience, calmness and firmness are more necessary.
Women with the best formed pelvis, and a regular presentation of the
head of the dead foetus, sometimes experience very lingering and pain-
ful labors. The dilatation of the os tincse and of the vagina is very
tedious. The rapid abstraction of blood from the arm, so as to produce
complete relaxation of the whole system, we have found to be the best
remedy. When the head of the child fairly presents in the vagina,
the assistance of the practitioner is important ; his hands are probably
the only instruments he will require.

There may be some other inconveniences attending the period of
gestation, but we pass them over, and proceed to consider the difRcul-
ties consequent upon labor.

Profuse haemorrhage sometimes occurs, and threatens immediate dis-
solution ; the means for arresting it are too well known in the Profes •
sion for us to allude to them. We think proper, however, to remark,

Dr. Host's Report on Midwifery.

575

that when vitality is almost extinct after the haemorrhage has been ar-
rested, the infusion of warm blood from the vein of a healthy person,
into a vein of the dying female, has restored life when hope had de-
parted. This fact was at one time a subject Gf doubt, but we consider
it now as well established.

Great inconvenience is occasionally suffered from the bad condition
of the mother's breasts. We merely allude to the fact.

Puerperal Fever is sometimes very embarrassing. Gooch, at page
269, says, that the cause is unknown. We beg to differ in opinion.
We think it may be traced to rough usage by an ignorant midwife, and
to the absence or suppression of the lochial discharge. It generally
ends, when fatal, in Peritonitis, and often when this is the case, all is
over in forty-eight hours- There is the same continuity in the serous
and mucous membranes, as there is in the nerves and fluids of the
human system ; hence the facility with which irritation at first, and
then subsequently inflammation, may be propagated. We consider the
idea of its being propagated by specific contagion as absurd in the ex-
treme. This assumed fact could never be ascertained in private prac-
tice, but in a crowded ward of a hospital, we know that there may be
a condition of the atmosphere, producing the same disease in different
persons, who may, at the same time, be obnoxious to its influence.
We consider inflammation of the uterus, which is treated of as a sepa-
rate disease, to be the first link in the chain of Peritonitis, or Puerpe-
ral Fever. Resolute depletion by the lancet, and cathartics with coun*
ter irritation, we all know, are the only means of conquering these ter-
rible sequelae of parturition.

Puerperal Mania, the result of severe nervous irritation, is spoken of
by the European writers. It generally disappears in the course of
two or three weeks, and is occasionally fatal. Rest is, in this case
the great remedy. There is ofteu a tendency to commit suicide, to pre-
vent which, every precaution should be adopted. Active purgation is,
in this predicament, the best remedy. The practice dates from the time
of Hippocrates, who prescribed the Heiliborus Niger. In Hooper's
Dictionary we read, that the ancients esteemed it as a powerful remedy
in maniacal cases, It is highly spoken of by Arssteus, Asclepiaedes
and others.

A very obstinate complaint of women after parturition is Phlegmasia
Dolens, which occurs in nearly about one month after delivery. The
seat of the disease is one of the thighs, from which it radiates in dif-
ferent directions. From the shining white appearance of the swelling,

576 The New-Orleans Medical and Surgical Journal.

so different from what we see when there is inflammation, we are lia-
ble to be misled. The pain and tumefaction, and tension of the skin,
clearly indicate excessive and morbid action somewhere. It has been
supposed to be the result of inflammation of the absorbent glands in
the groin, and the consequent diffusion of lymph in the cellular mem-
branes. Bleeding, purgation, sudorifics and opiates are the remedies
recommended by the highest authorities.

Inversion of the uterus sometimes occurs, because the uteruss does
not contract after the birth of the child ; it may be produced by a very
slight force applied to the umbilical chord, in the attempt to extract the
placenta. This is sometimes a very serious affair, terminating in death.
We have not time to speak of the diversities of the case, or the re-
medies that are necessary.

Having, as briefly as we could, disposed of the principal diseases
and inconveniences prior and subsequent to parturition, — not one of
them being, as we believe, decreed by Deity, but altogether the result
of civilizatian, and departure from the great principles of nature and
common sense, we shall conclude this division of our subject with a
few summary remarks.

Where there is unfortunately great deformity of the pelvis, rendering
the delivery of a live child by the natural passages impossible, it is evi-
dent that in case of marriage and impregnation, the danger both to the
mother and the child must be extreme.

The best advice a family Physician can give under such circumstan-
ces to a female is, never to think of marriage. Nine times out of ten,
the advice will be disregarded, but the Physician will have done his
duty, and the woman must abide the consequences.

Many newly married females have great fear (much as the mother
desires to have a child) of the period of parturition. Instead of calm-
ing apprehension by every rational argument, injudicious female friends
frequently speak to them of the terrible suffering and great peril of
giving birth to a child, until the impression is indelibly fixed in the mind
that the suffering and the peril are the result of destiny, or of an arbi-
trary decree of Deity — and hence they have to meet an event common
and natural to all females with a diseased imagination and a diminished
vitality. We may readily imagine the result to be a tedious labor,
often complicated with unpleasant and even dangerous circumstances.
The female should be taught to believe that impregnation, gestation,
and parturition, are as natural as the action of any other functions of the
body, and if the idea of peril is suggested, let it be considered as an

Dr. Hort's Report on Midwifery.

577

exception to a general rule, and to an universal principle amongst all
living entities. As to pain, the fear of every female may easily be re-
lieved, as we have before stated, by being assured of the beneficial
effects arising from the use of chloroform. All these are moral consid-
erations.

When we see a lady rising at about eleven o'clock in the forenoon,
after having taken her breakfast in bed, and then lolling in a kind of
dreamy condition on a sofa, with a fashionable novel in her hand — we
pity the woman, and we pity the child to whom she may give birth.
This is the basis or foundation of difficulty. Its effects may be imper-
ceptible at first, but after a few generations we shall meet with deformed
pelves, rickety children, and a degenerating population. Early rising,
exercising in the open air, and activity in the house from the garret to
the kitchen, conduce to vigorous health in the mother, which is entailed
on her children. We have seen some of these indefatigable women
attacked, when pregnant, with yellow fever, and recover ; and in one,
two, or three months, give birth to vigorons and healthy children. So
much for regimen.

The question of diet is conditional. Those who are indolent have
the depraved appetite — which they will indulge. But the woman of
energy and activity is generally exempt from every thing of the kind,
and is satisfied with the ordinary substantial and wholesome fare of the
family circle.

We have said enough to illustrate our views. Difficulties in labor
arise from that civilization, where there is the greatest departure from
natural laws ; where luxury and indolence enervate the muscular
power and depress the vital energy. We must hasten to the conclusion
and say a few words about the diseases of children. So many admira-
ble works have been written on this subject, which are familiar to the
medical profession, that we do not deem it necessary to speak in detail
of the various incidental diseases of childhood. There is one thing,
however, well worthy of remark — the children of the laboring classes
seldom die, in comparison with the children of the wealthy. It is not
only that the stamina of the working classes is superior to that of other
classes ; it is also because comparatively no care is taken offtheir chil-
dren ; they are confided to natural laws, and are left to rough it, as the
saying is, in mud and water and in the open air. By degrees they be-
come robust and vigorous, with limbs, and muscles, and countenances,
indicative of health and strength. We have known parents who have
adopted the opposite course to lose child after child, whose escape from

578

The New-Orleans Medical and Surgical Journal.

a world of misery, rendered so by improper treatment, might rather be
considered as a blessing than as a misfortune.

When we see nauseating drugs, and worse than all, opiates, admin-
istered day after day, and sometimes hour after hour, for every imagin-
ary suffering, to an unfortunate child, a Physician of experience may
readily predict the result. The very anxiety of the parent is the cause
of its premature death.

Thank God, this is not an universal practice in the families of the
independent and the rich, or it would be most calamitous to the interests
of our country. It is altogether (as we said of the mothers) a condi„
tional state of things, and not a rule absolute with children. The same
argument used in the case of the mother, applies with equal force to the
child.

Great principles are abiding, conservative, and operative. We cul-
tivate plants and crops, and attend to the wants of inferior animals by
the teaching of experience, so as to produce the greatest result. Do
the same with your children, if you love this glorious Republic, and re-
vere its institutions, the product of as pure, and good, and wise men as
ever lived.

In the treatment of infants and very young children, one idea should
be invariably impressed upon the mind- — that is — their superior vitality,
as compared with persons of mature age. We know that infants and
children die in spite of skill and experience ; but as a general rule,
they resist disease in an extraordinary manner ; and recover, where a
strong man would succumb. This is owing to a natural law* The
more infants and young persons are kept in the open air, and exercised
in every possible way, the better for them ; and as a general rule, the
less medicine they take, the better for them also. Whilst the physical
development is going on, there is more energy in all the functions of
life than at any subsequent time. Many of us may envy them their
power of digestion, and their almost unsatiated appetite. The great
development of intellect generally commences, when the physical growth
and perfection are consummated. About the time that the latter begin
to decay, intellect, emancipated from a temporary predominating power,
begins its career of all that is benign in society, progressive in arts
and sciences, and glorious in its god-like sphere of genius. We allude
to this at the close of our address, because it demonstrates to the Phy-
sician, the difference of treatment that is required for the mother and
the child. Moral and intellectual power avail most with the first; while
physical or physiological considerations belong peculiarly to the latter.

Dr. Hort's Report o?i Midwifery.

579

If we attempt to point out any line of demarcation between these two
periods, we would assign it to the period of puberty. Although at that
time the physical structure has not attained its full vigor, the progress of
intellect may yet be very evident ; we must not, however, expect to see
it in its full power. There may be quick perception, retentive memory
and much imagination or fancy — the dawnings of that mature judgment,
which rarely develops itself until nature has accomplished the highest
perfection of the physical frame.

We shall now conclude with a brief synopsis of the plan we have
adopted. We have — -

1. Endeavored to give a brief history of Midwifery.

2. We have alluded to some of the eminent men in various parts of
the world who have lectured and written, on the subject.

3. We have contended that the "sorrow" spoken of in the Bible as
entailed upon the female sex, is moral suffering positively and physical
suffering conditionally,

4. We have adverted to the powers of nature in carrying out her
own laws, and maintained that it is better to trust to natural laws than
to instruments or to nostrums.

5. We have attempted to show that the physical suffering is the re-
sult of civilization, luxury and sensuality — first causing the race to de-
generate physically, morally and intellectually, and finally producing
physical deformity.

We have spoken of the superior vitality of children up to the time ot
puberty — and of the best manner of treating and managing them, which
is according to natural laws. And finally, we may lay it down as an
aphorism, applicable to both young and old of both sexes, that every
departure from natural laws involves more or less physical suffering.

However men may speculate as to the modus operandi of anaesthetic
agents, one thing is certain, whether complete insensibility or stupor
be produced by chloroform, or whether the same agent totally removes
the sense of pain, consciousness being at the same time retained, it all
amounts to the same thing — parturition is accomplished like any other
natural process which is carried on by vital laws — and without the
agency of volition — precisely as the heart beats ; as the blood circu-

580

The New-Orleans Medical and Surgical Journal.

lates ; as digestion, absorption and assimilation take place. For one
purely natural operation in man, the highest on the scale of animal
creation, is similar to all kindred operations in the inferior animals,
even down to the Zoophites and Infusoria, and the most obscure con-
necting links between the lowest of the animal and vegetable en-
tities.

II.— DISLOCATION OF THE OS HUMERI UPON THE DORSUM
SCAPULAE, REDUCED AFTER THE EXPIRATION OF FIVE

WEEKS.

BY PAUL F. EVE, M. D.
Professor of Surgery in the Nashville University.

[We are indebted to Professor Eve for the proof sheets of the follow-
ing instructive case in surgical practice, which goes to demonstrate
what perseverance, joined to skill, may accomplish, under the most dis-
couraging circumstances. We regard Prof E. as one among the first
practical Surgeons on this side the Atlantic. Ed.]

Mrs. A. was thrown from a carriage while the horses were running
away with it, and in the fall was struck by a wheel upon the left shoul-
der. This occurred just five weeks, lacking a day, before the disloca-
tion, (the result of this accident) was reduced* Owing to the great tu-
mefaction which immediately ensued, the peculiar nature of the injury
was not detected. When this had subsided, her physicians recognized
a dislocation, which was so unusual that she was advised to visit Nash-
ville. Doctors Kelly and Porter examined the case with me on the
*21st of November, and we confirmed the opinion already expressed by
our professional brethren who had seen it, that there was a dislocation
backwards of the humerus at the left shoulder-joint. This decision
was further strengthened the next day by Doctors Jennings and D. W.
Yandell concurring with us.

The symptoms present were a loss of contour in the articulation af-
ected, motion backward and upward of the left arm ; flatness of the
shoulder, great projection of the coracoid process, prominence of the
acromion, hollow under it ; a distinct tumor on the dorsum scapulae, be-
hind and a little below the glenoid cavity ; the spinous process of this
bone was obscured ; the tumor on its dorsum was much nearer its pos-
terior edge than was the head of the humerus on the sound side to the
corresponding point of that side; the longitudinal axis of the os humeri
was directed behind the glenoid cavity ; the left fore. arm was pronated.

Dr. Eve on the Dislocation of the Os Humeri.

581

The inferior extremity of the dislocated limb was longer than the one
on the other side. There was no tumor in the axilla, and the elbow of
the affected side could be made to approach the chest.

The patient did not now suffer much, but could only use the
fore-arm to a limited extent, and the function of the arm was nearly
lost.

The peculiar symptoms in the case were the altered direction of the
long axis of the arm, the impossibility to carry the elbow backwards,
the projection of the caracoid process, and the head of the os humeri on
the dorsum scapulae.

Kindly assisted by the gentlemen above mentioned, while one main-
tained counter-extension by means of a folded sheet in the axilla, (the
patient being seated in a chair) two others extended the limb horizon-
tally outwards and forwards, with directions to carry it suddenly back-
wards, the head of the os humeri was pressed towards the glenoid ca-
vity, when the reduction was easily effected, without resorting to chlo-
roform or the pullies. Upon the second trial, probably in three min-
utes, the bone slipped into its socket with distinct recognition to all
present. In a week the patient returned home, a distance of about 30
miles.

That the backward dislocation at the shoulder-joint is a very rare
one, a mere glance into the records of Surgery will satisfactorily prove.
Its bibliography does not extend beyond the present century. Cases
no doubt have occurred earlier than this period, but nearly all available
in the profession have been derived from modern Surgeons.

In Professor Perrie's Principles and Practice of Surgery, 1852, on
dislocations backwards at the shoulder-joint, he says that " of the head
of the humerus on the dorsum of the scapula is so rare an accident,
that Desault had never seen an instance of it ; Baron Boyer met with
it once in the living body ; only two cases occurred at Guy's Hospital
in thirty-eight years ; in the same number of years Sir Astley Cooper
met with two cases, and not more than four cases occurred in his prac-
tice during his whole professional career ; and Mr. Lawrence, in his
lectures, delivered at St. Bartholomew's Hospital in 1830, states that at
that time he had never seen the humerus dislocated backwards. After
alluding to three or four other cases, and two examples he had met with,
he concludes the paragraph by stating, that there are on record a few
others.

Mr. Bransby Cooper, in his lectures on the Principles and Practice
of Surgery, published last year, writes that Boyer, speaking of this ac-

582 The New-Orleans Medical and Surgical Journal

cident, says, " there is no well attested instance of dislocation of the
humerus outwards and backwards." He states, however, that he him-
self had seen several cases ; alluding, clearly, to some of his uncle's,
Astley ; and reminding an American of a similar connecting of E. Home
to the celebrated John Hunter. But he, too, referring to his illustrious
relative, remarks, that it was singular that two instances of so rare an
accident should occur so closely together in the practice of one individ-
ual. In Sir Astley Cooper's great work on Dislocations, we find these
very cases detailed. In the other Cooper's writings (Samuel) he states
distinctly a few cases have been recorded. Ferguson has seen one in-
stance ; Listen,* Miller and Skey mention none.

During the visit of my colleague, Dr. Buchanan, last year, to Saint
Bartholomew's Hospital, the first case of dislocation of the head of the
humerus on the dorsum of the scapula, was brought into that institution.
Mr. Stanley said it was the first of the kind he had ever seen, and he
had been connected with it 30 years. Mr. Lawrence stated that he had
met with but one other in 50 year's practice.

In our own country, Dr. Physick, if we recollect aright, met with two
such dislocations. One was produced by the patient falling into a hatch-
way and striking the arm near the shoulder-joint upon its edge as the
body descended into it. In this instance, the blow or force causing the
luxation was applied directly opposite to that which resulted in a similar
accident to the case here recorded. In my example, the wheel struck
the scapula posteriorly, carrying it suddenly and forcibly forward, while
the arm, fore-arm and hand, having no such movement communicated
to them, by their dead weight, overcame the slight comparative resist-
ance of the atmosphere, ruptured the scapulo-humeral articulation, and
were thrown backwards.

In 1831, Dr. George Snider, of Jackson, Tennessee, communicated
a case of backward dislocation at the shoulder-joint to Prof. Gibson of
Philadelphia, in which not succeeding in effecting its reduction, as re-
commended by Sir Astley Cooper, he afterwards replaced it by the ordi-
nary means applied to luxation of the os humeri in the axilla. Dr. S.
has made the very sensible remark, that producing a secondary or con-
secutive displacement of the humerus downwards, which some authors
recommend, cannot facilitate the reduction*

To be reduced from its second position, it must necessarily increase

* See Elements.

Dr. Scruggs on the use of Cod Liver Oil- 583

the rupture in the ligaments or soft parts, or describe a curve to enter
again the glenoid cavity.

The case now recorded, we believe, is the first of the kind occurring
in or about Nashville.

Nashville, January, 1 853,

III.— OBSERVATIONS ON THE USE OF COD LIVER OIL IN
THE TREATMENT OF TUBERCULAR AND OTHER HETEROLO*
GOUS AFFECTIONS, ILLUSTRATED BY CASES.

BY R. SCRUGGS, M. D., OF LA.

Previously^ the introduction of Cod Liver Oil into the Profession in
this country, as a therapeutic agent, I was in the habit of relying chiefly
upon the preparations of iodine, in the treatment of tubercular and other
heterologous diseases, and generally with very satisfactory results.
Since, however, this and other oils have been brought prominently be-
fore the Profession, I have constantly availed myself of them in my
practice, and with a steadily increasing confidence in their value ; not-
withstanding which, I have by no means discarded from my list of val-
uable agents those with which I was accustomed formerly to grapple
with these formidable maladies.

After carefully studying the books, and listening attentively in the
schools to the discussions which there arose, as to the inflammatory or
non-inflammatory origin of tubercle, I adopted the latter as the most
plausible theory, upon which my treatment of these diseases has since
been based. This opinion, however, has not prevented me from using
the necessary antiphlogistic treatment, but it has prevented me from
pushing it to the extent recommended by the advocates of the opposite
theory ; and although I would not like to assert positively that in no
case of tubercular disease ought general blood-letting to be practised,
yet I do assert, (according to the best of my judgment) that no such case
has been presented to me in my practice. The opinion of the inflam-
matory origin of tubercle has led, frequently, to the adoption of a most
active antiphlogistic treatment, which, in my opinion, is calculated ra-
ther to favor the deposition of tubercular matter, than to cause its re-
moval. It has occurred to me to observe the course of a few cases
thus treated, but the results were not such as to encourage me to adopt
that plan of treatment myself.

Believing the tubercular matter to be a heterologous formation, de*

584 The New-Orleans Medical and Surgical Journal.

posited by the blood-vessels in particular tissues or organs, (the prefer-
ence thus shown not being readily understood,) caused by a depraved
condition of the constitution, either acquired or inherited, and that i*
was itself frequently, if not always, the cause of inflammation of the
tissues in which it was deposited, and consequently the cause also of
the febrile disturbances so often accompanying the local inflammation;
I regarded the indications of treatment to be, first — to relieve the local
inflammations and general vascular excitement ; secondly — to cause
absorption of the foreign matter ; and lastly, to prevent a still further
deposit of it if possible. To accomplish which, I depleted locally and
enforced strictly the antiphlogistic regimen first ; then applied counter-
irritation over the affected parts, (usually an issue made with the Pate
de Vienne) putting the patient upon a more generous diet as the in-
flammatory symptoms gave way, and at the same time used the prepa-
rations of iodine as an alterative calculated to favor the absorption of
the foreign matter ; and lastly, besides insisting upon such hygienic
rules as were deemed best calculated to improve the general health,
gave the syrup of the iodide of iron, as both alterative and tonic, with
the view of causing the removal of whatever tubercular matter might
still remain, and prevent a still further deposit of it. By this plan of
treatment, I believe that I have succeeded in arresting the disease in
several cases of incipient Phthisis. I recollect the case of a negro
girl, about fourteen years of age, who was brought to me for examina-
tion in the year 1845, in which this plan of treatment seemed to answer
admirably. She presented an ashy, cachetic appearance, had slight
wandering pains in the chest, and a very harassing cough, which, hav-
ing commenced about two months before, and growing gradually worse,
in spite of expectorants, warm teas, purgatives, etc., which had been
administered to her from time to time ; her mistress became alarmed
about her condition and brought her to me for treatment. Upon exa-
mination, there was fo und very decided dulness upon percussion at the
apex of the right lung, with rude or bronchial respiration underneath
the clavicle ; the remainder of neither lung presenting any other ab-
normal sound whatever.

Had this condition existed only for a short time, and the abnormal
sounds been heard in any other part of the lungs, I should have conclu-
ded that it was simply a case of circumscribed pneumonia or bronchi-
tis ; but considering its location at the top of the lung, in connection
with the history of her family (which was scrofulous) and the very
gradual manner in which the disease had progressed, [ without much
hesitation gave it as my opinion that it was a case of tubercular phthi-

Dr. Scruggs on the use of Cod Liver Oil.

585

sis, in its iirst stage. An opinion which, by the way, gave me but lit-
tle credit with the family at the time, who, seeing the symptoms yield
so readily under the treatment instituted, concluded that the Doctor had
magnified the importance ofthecase, in order to get greater credit than
he deserved for the cure. This very uncharitable opinion of me caused
them to neglect the instructions given them upon my dismissing the
case ; a circumstance that they much regretted afterwards, when, ac-
cording to my prediction, the symptoms returned with increased vio-
lence.

The patient was brought to me again, but for obvious reasons I de-
clined treating the case. She was then sent to Dr. John R. Buck of
Louisville, Kentucky, a gentleman somewhat distinguished as a lec-
turer, and remarkable for the accuracy with which he diagnosticated
tubercular diseases. Dr. Buck, after a careful examination of the case,
unhesitatingly pronounced it a case of tubercular phthisis.

The treatment which so speedily relieved the patient at first, was
briefly as follows :

I applied a cup below the right clavicle, and abstracted five ounces
of blood, which was nigh producing syncope. I then put her upon milk
and bread diet for several days; then established an issue, the size of
a ten cent piece, in the centre of the part cupped ; put her upon the
use of Sol. Iod. Potas. for a time, and afterwards gave her tea spoonful
doses of the Syrup of Iodide of Iron three times a day, increasing the
quantity and improving the quality of her diet, as the inflammatory symp-
toms gave way. Under this treatmeat she improved so rapidly, and
was apparently well so soon, that it induced the belief, as before re-
marked, that but very little ailed her at first.

My experience in the use of Cod Liver and other Oils since, induces
me to believe that this case might have been radically cured had the
oil been commenced at the time I dismissed the patient, and continued
a sufficient length of time ; observing, of course, proper hygeinic rules,
etc., during the treatment.

Another case to which I was called during the year 1845, and which
interested me very much at the time, was a negress aged thirteen. She
however was so much reduced by disease at the time I first saw her,
that her master had altogether despaired of her recovery ; but being
a humane man, requested me to call and see her, and attend her as
long as she should live, which he thought would be but a short time.
Both lungs seemed to be diseased throughout their entire extent, but
there was no evidence of the existence of a cavity. There was great

566

The New-Orleans Medical and Surgical Journal.

emaciation, an accelerated and feeble pulse, and a most distressing
cough, with copious purulent expectoration. I found also a fluctuating
tumor in the depression above the right clavicle, which, upon being
opened, discharged a lump of cheesy looking matter, the size of a par-
tridge egg, along with a serous fluid, in which it had floated. The
mother of the girl immediately remarked, without being questioned,
that it was precisely such looking stuff as Hester had frequently
coughed up. The ulcer produced by this was a long time in healing, a
circumstance that I did not much regret, as I thought it might answer
the purpose of a seaton or issue. I will not attempt to give a detailed
account of the treatment, but will only state, that with the various pre-
parations of Iodine, Iron and Sarsaparilla, along with counter irritation
with blisters and Tart. Emetic Ointment over the chest, and such adju-
vant treatment as was deemed advisable from time to time, the girl
gradually recovered her health. I saw her three years afterwards,
when she was a fully developed woman. She then had the appearance
of excellent health, but her mistress informed me that she was very
delicate, could stand but little hardship, and that the cough and other
unpleasant symptoms would invariably return upon her after the slight-
est exposure. I advised the use of Cod Liver Oil, which was given
her, and two years after that, I learned that she was in fine
health.

In the year 1847 I was requested to examine a negro man, about
38 years of age, who, it was stated, had been in a lingering condition
for several months. His parents had both been taken in the same
manner, and died, after several months of lingering disease ; which
had caused in the family the vulgar apprehension that these negroes
had been poisoned or conjured — a very frequent and unfortunate su-
perstitious error amongst # the ignorant, in cases of negro consumption.
By the physical signs, it was readily ascertained that a large cavity
existed opposite the third rib on the left side, while the duiness on per-
cussion and the absence of the healthy auscultatory sounds, rendered it
probable that nearly the whole of the left lung was filled with tuber-
cular matter. Add to this the general symptoms, and there could be
no hesitation in pronouncing it a case of tubercular consumption in
the last stage.

Being requested to prescribe for him, I introduced a seaton, to mark
the situation of the cavity, and left some directions for his treatment,
intended rather to smooth the path to death, than with any hope of
permanently benefitting him. Of this 1 informed the master, telling
him, at the same time, that although I could not promise to cure his

Dr. Scruggs on the use of Cod Liver OiL

587

negro, I could, nevertheless, render him a very essential service, by
disabusing the minds of his family of a very unfortunate error, and
at the same time put him upon a plan of managing the children of
the patient, (of which there were five, all presenting palpable eviden-
ces of the scrofulous diathesis) in a manner that might possibly ward
off the predisposition to tubercular disease inherited from their father.
Six weeks afterwards he died, and I made a post mortem examination
in the presence of the family, a few neighbors, and several Physicians*
A very large suppurating cavity was found just underneath the seaton,
the lung being filled above and below the cavity with tubercular
matter. Having, previously to making the examination, confidently
stated my opinion of the condition of the lungs, and this opinion being
so exactly verified by the autopsy, it gained forme the entire confidence
of the family, and thus enabled me to dispel the gloom which had long
depressed them, by putting to flight those vague and uncertain fears,
known only to the ignorant and superstitious.

I will now proceed to give, somewhat in detail, the history and treat-
ment of fbur cases, each differing from the others in some important
particulars, yet all belonging to the family of heterologous diseases.
They have been selected from amongst a considerable number of cases
treated by the author with the Cod Liver and Phosphorated Almond
Oils ; with the hope that they might prove of some little use in deter-
mining the value of these and other oils, in the treatment of heterolo-
gous and other diseases,

CASE FIRST.

Mrs, C, a native of Virginia, set. 45, mother of ten children, all liv-
ing and apparently healthy, except slight tendency in two or three of
them to enlargement of the tonsils. Mrs. C. is of medium stature,
light hair, blue eyes, and extremely delicate appearance ; temperament
eminently nervous ; has that peculiarity of constitution which has al-
ways rendered her obnoxious to those asthmatic symptoms produced in
certain individuals by the taste or smell of Ipecacuanha ; says that she
has several times been reduced to the greatest extremity by taking
Ipecac, administered to her by Physicians unacquainted with this idio-
syncracy ; never could take the smallest quantity in any combination,
nor smell Ipecac, without at once suffering the most violent dyspnoea,
which would sometimes pass off in two or three days, but would fre-
quently last for more than a week.

About the 1st of August, 1851, she was taken with a pretty severe

588

The New -Orleans Medical and Surgical Journal*

cough, with a slight fever, which continuing with increasing intensity
for ten days, I was sent for. I found her a good deal emaciated ; pulse
small, and about one hundred beats to the minute ; tonsils enlarged and
ulcerated ; also inflammation of the larynx, and some difficulty in deglu-
tition ; bowels obstinately constipated. She complains of pain through
the right lung, extending to the right hypochondrium ; has violent fits
of coughing, at the commencement of each paroxysm a quantity of very
offensive matter is expectorated. The irritable cough continues for
several hours after the expectoration of this accumulated matter, the-
sputa then being small in quantity, and composed of a glairy mucus
mixed with pus, and occasionally mixed with blood. The intolerable
foetid breath, along with the mixed character of the expectorated mat-
ter, made it clear to my mind that there was gangr ene of a portion of
the lung accompanying the tubercular deposit.

Physical Signs. — Left lung — Percussion and auscultatory sounds
nearly natural. Right lung — Dulness upon percussion over the upper
and lower parts, with preternatural resonance over the mammary re-
gion. Upon applying the ear over this region, there could be heard
cavernous respiration, gurgling, various musical sounds, pectoriloquy,
and indeed all the evidences of a considerable cavity. Pectoriloquy
was most distinct at the lower part of the base of the right scapula.

Treatment. — Local depletion with cups,followed by warm cataplasms;
low diet ; bowels to be moved with Comp. Cath. Pills, and afterwards
to be kept soluable with mild aperient medicines. This was continued
for several days, when blisters were applied, with directions to keep
them running, and the patient put upon the preparations of Iodine ; the
diet to be increased in strength and quantity as the appetite improved.
She took first the lod. of Potas., and afterwards the Syrup of lod. Iron.
This treatment was continued for four weeks without producing any
very marked change in the condition of the patient. The cough dur-
ing this time continued, although somewhat controlled by various ex-
pectorant mixtures, and large quantities of very offensive matter con-
tinued to be expectorated.

I then commenced with Cod Liver Oil in tea spoonful doses, three
times a day, to be gradually increased if the stomach would tolerate
it. The oil was administered in sweetened water acidulated with ni-
tric acid ; a very excellent way of disguising the unpleasant taste of
the oil, and believed also to be a valuable adjuvant in many cases.
The patient could take the oil without its producing any nausea, and
the dose was increased in three weeks to a table spoonful three times

Dr. Scruggs on the use of Cod Liver Oil.

539

a day. It seemed to fulfil several indications admirably : to allay cough,

to quiet nervous irritability, to keep the bowels right, and to fatten the
patient. She improved very rapidly, and left here for Texas about
the 1st of December, 1851, appearing and feeling as well as she had
for many years. There was evident shrinking of the diseased side of
the chest, and the physical signs of disease still remained. I advised
her to continue the treatment, both general and special, for a long time;
not, however, to take medicine constantly, but to keep a watch upon
herself, and use the means pointed out to her at irregular intervals un-
til she felt perfectly secure.

I have frequently heard from her since she left here. She has en-
joyed, generally, pretty good health, although she has had several at-
tacks of the endemic fever common to her place of residence. In
spite of this, and many depressing moral agencies, not the least of
which may be mentioned, pecuniary difficulties in providing for her nu=
merous family ; she still keeps up her spirits and enjoys a comfortable
share of good health. For which she is disposed to give the chief cre°
dit to the Cod Liver Oil.

CASE SECOND.

Mrs. S., set. 22, mother of one child two years old ; is rather tall,
handsome figure, with dark hair and eyes ; has a very amiable disposi-
tion, is quiet and lady-like in her manners. She had suffered for six
months before I saw her with what was believed to be tubercular
consumption, and had been confined to her bed nearly the whole of
this time. Her condition and appearance when I first saw her, (Feb-
ruary 12th, 1852) was well calculated to confirm the opinion of the
existence of phthisis : pale, greatly emaciated, pulse feeble and slightly
accelerated, and an almost incessant cough; the sputa abundant and
apparently muco-purulent. But upon a careful examination of the chest,
the physical signs did not absolutely confirm the opinion of the exist-
ence of tubercular deposit, at least in the parenchymatous structure of
the lungs. If it had been deposited then at all, it must have been upon
the free surface of the mucous membrane. The sounds elicited by
percussion were somewhat dull, but the dullness was nearly uniform
over both lungs. Auscultation showed that both lungs were permeable
to the air throughout their entire extent, and the only abnormal sounds
heard were the mucous and sub-crepitant ronchi. There were one or
two tender spots along the course of the dorsal spine ; the spleen con-
siderably enlarged, and the bowels irregular ; sometimes acting too
freely, and at other times inclining to constipation. From what could

590

The New-Orleans Medical and Surgical Journal.

be learned of the history of her family, there could be no suspicion of
hereditary vice of the constitution, or predisposition to tubercular dis-
ease.

Treatment.— The tender places along the spine were scarified and
cupped ; the anterior part of the chest was covered with a Burgundy
Pitch Plaster, as also the enlarged spleen ; the plasters being first
sprinkled over with Tart. Emet. Directions were given to have the
spine well rubbed twice a day with a linament which was to be com-
posed of —

Aqua Ammonia ) ~ .

01. Olivarum a a )
Tine. Opii, gtts. lx
Chloroform

Spts. Terebinth, a a $ 3 ij M

The feet to be kept warm, and an occasional hot stimulating foot bath
to be used ; flannel to be worn next the skin, the diet to be nutritious
but not stimulating, the bowels to be kept soluble with tea spoonful
doses of cream of tartar, magnesia and sulphur, (equal parts by mea-
sure) and the cough allayed with the following mixture :

^ Mucilage G. A. § vj

Acet. Morph. grs. ij

Acid. Hydro, gtts. xv

(Medicinal) Syrup Limon. 3 iv M.
S. A table spoonful pro re nata .

This expectorant answered the purpose so well, that it was continued
as long as the cough lasted.

Having been informed by her that her stomach would not tolerate the
Cod Oil, I directed her to take tea spoonful doses of Phosphorated Al-
mond Oil three times a day (1 grain phosphorus to § xvj oil). The im-
provement under this treatment was rapid, and in the course of a few
months her health appeared to be entirely restored.

It may be doubted whether this was a case of tubercular disease. I
readily admit that the diagnosis was formed more from the general
symptoms than the physical signs of tubercular deposit.

CASE THIRD.

C, a black negro, of small stature, set. 35, mother of five children.
Her youngest child is three years old, since the birth of which her
general health has not been good, although she has usually been wetf

Dr. Scruggs on the use of Cod Live?- Oil.

591

enough to do her ordinary work, as a field hand, on the plantation. She
has never been right in her courses since her last accouchement, at
which time she thinks she was seriously injured. Thought, until ex-
amined, that she had *' only falling of the womb," with " whites," al-
though she suffered often with sharp lancinating, alternated with dull,
heavy pains in the small of the back, lower part of the belly and left
side ; the discharge being all along profuse, offensive to the smell, and
often bloody. While working in the field, has frequently found it ne-
cessary to lay down upon her back, elevate the hips, and push the
womb up, to prevent it from protruding externally. When this was
done, she would apply a compress and T bandage to retain it in its
position.

The parts, upon my first examination, made April 28th, 1851, pre-
sented a frightful amount of disease. By separating the labia with the
fingers, without the use of the speculum, the diseased mass could be
brought into view. It filled the vaginal canal, was deeply fissured and
ulcerated, had a rather spongy and granulated feel externally, but felt
more gristly upon passing the finger to the bottom of the ulcerated fis-
sures. It appeared to spring from the whole circumference -of the os
uteri. The discharge was of a dark color, sero-purulent, and most
intolerably foetid. The examination caused it to bleed very freely. I
invited several physicians to see the case, one of whom had had con-
siderable experience in the treatment of uterine diseases ; all agreed
that it was the worst looking case that they had ever seen, and believed
that it was cancer of the uterus. That was also my opinion, but I be-
lieved that it was originally cauliflower excrescence, and had become
complicated with carcinomatous or encephaloid deposit.

Six leeches were applied, which filled quickly, and after they fell off
the bites bled very freely, and continued to bleed for some time ; so that
a good deal of blood was lost in this way. Directions were left for the
bowels to be kept open, and the vagina to be syringed out several times
a day with simple warm water, and the patient to retain the recumbent
posture.

On the 6th of May I cauterized the diseased parts very severely,
with Potassa Fusa. This operation was performed three times, at in-
tervals of one month, in the manner directed by Dr. J. Henry Bennet,
protecting the surrounding parts with cotton, saturated with vinegar.
Once, and sometimes twice, in the intervals of the severer cauteriza-
tion, the parts were dressed with Argt. Nit. The pain produced by
these applications was inconsiderable at first, in the parts to which they

592 The New Orleans Medical and Surgical Journal.

were applied ; but as the case improved, she complained very much of
pain there, as well as in the region of the uterus, where it had been
severely felt upon the first application of the caustic. Directions were
always left to have a quantity of warm water thrown up the vagina se-
veral times a day, to cleanse the parts, as well as to foment them ; and
also to use astringent washes to moderate the discharge, in addition
to the local treatment, she took alteratives and tonics, had blisters and
frictions to the spine, warm fomentations over the bowels, etc. Indeed
no adjuvant treatment was neglected that I thought could be of the
slightest benefit to her. In this way the diseased mass was finally got rid
of, so that about the middle of July, when I called to see her, she was
up, very cheerful, and doing the work of a house servant, without any
appearance of disease, or any inconvenience to herself whatever. Upon
examining the parts with the speculum, it was found that the whole of
the diseased mass had sloughed away, the womb mounted up to its na-
tural position, and nothing remaining but a healthy looking ulcer, the
size of half a dollar, on the cervix uteri. This was dressed with Argt.
Nitr.

I did not see her again for six weeks, when 1 expected to find her
nearly or quite well, but in this I was sadly disappointed. The over-
seer, thinking that she was well, put her to cooking for the negroes, the
weather being extremely hot during the time and to my great surprise
and mortification, I found, upon examination, that the disease had been
reproduced, and looked nearly as bad as it did at first. It looked black,
had the same granular and spongy feel externally ; was extensively ul-
cerated, and discharging a sero-sanguinolent matter mixed with pus, the
stench being most intolerable.

I again cauterized extensively and deeply with the Potassa Fusa,
This time the cautery produced a most alarming condition. I returned
to see her the next day, and found that she had been suffering most in-
tensely. There was an irregular spasmodic action of some of the mus-
cles, while the jaws were nearly locked ; a condition very nearly ap-
proaching to tetanus. She was unable to pass her urine; all that was
passed dribbled away involuntarily. I introduced the catheter and
drew off about a pint of urine, gave her a large dose of morphine, with
directions to repeat it when necessary ; moved the bowels with ene-
mata, injected a quantity of flaxseed tea up the vagina, rubbed the spine
with Chloroform linament, and applied warm fomentations over the
abdomen. With these means the pain, and other untoward symptoms,
were finally relieved, and I then put her upon the use of Cod Liver Oil-
From this time her improvement was rapid. Indeed in one month she

Dr. Scruggs on the use of Cod Liver Oil.

593

was up and again about, as though nothing had been the matter with
her, and said she felt almost well. Upon examination, I found that
the disease was again reduced to a small, healthy looking ulcer kupon
the cervix uteri, and but little discharge from it. I touched it lightly
with the lunar caustic, gave her medicines with general directions, and
she was removed to a plantation twenty-five miles distant from me. I
saw nothing more of her for several months, and thus had not an op-
portunity of examining her. This I regretted very much, for I wished
to ascertain certainly whether a perfect cure couldj3e effected or not.
Her master informed me last spring that she was quite well ; but I
learn that she has since died ; but whether of the uterine or some other
disease, I could not ascertain.

CASE FOURTH.

In this, the last case that I shall notice at present, the superior vir-
tues of the oil were displayed more conspicuously than in any case 1
ever treated with it.

A little negro girl, about eight years of age, presenting not only the
scrofulous diathesis, but having the disease fully developed at the time
my attention was first called to him, in October, 1851. The absorbent
glands about the neck, parotid, submaxillary and salivary glands were
all very much swollen, and the tonsils enlarged and ulcerated. The
conjunctiva were considerably inflamed, with the little pustular erup-
tion upon them, said to be almost pathognomonic of strumous opthal-
mia; while such was the intolerance of light, that the little fellow would
keep his eyes covered all day, never venturing to look around him un-
til after sun-down.

Without any previous or adjuvant treatment, except to sponge his
husky, dry skin with " pot liquor," (the water in which bacon has been
boiled) which was done at the suggestion of the little negro's mother ;
a little aperient medicine, and bathing his eyes with a mucilage of the
pith of sassafras ; he was put upon the Cod Liver Oil, in tea spoonful
doses three times a day ; the oil being administered as usual in nitric
acid water. The oil was also used by inunction. The improvement
was so rapid, that he appeared to be entirely well before the first bot-
tle of oil was exhausted. He was then neglected for a month or two,
when the disease returning, he was again put upon the use of the oil,
and again the disease rapidly disappeared. This time I advised a
continuance of the oil for a considerable time after the boy appeared to

504 The New -Orleans Medical and Surgical Journal.

be well, which was done, and there has been no return of the disease
up to the present time.

In this case there could be no mistake as to the medicine which had
accomplished the cure, as might sometimes occurjin chronic cases of
long standing, where a great many different agents had been used,

Shreveport, La., 1853.

IV.— PUERPERAL CONVULSIONS.

BY S. B. MALONE, OP MISS.

Case No. I.

Mrs. — , aged 28 or 30, figure tall and of large size, complexion

fair, light hair, blue eyes, high intellectual attainments and social posi-
tion; has been married about a year. June 5th, 1840, was called on
to attend her in her first confinement, at 7 o'clock, P. M. Pains regu-
lar but light; labor progressing slowly.

At 11 o'clock stepped into her room, and on placing my fingers on
her pulse, found it full and bounding ; artery felt as large as one of her
fingers ; immediately corded her arm ; but before I could open a vein
she went into a violent convulsion, during which I opened a vein, with
a large orifice, and took a large sized wash bowl nearly full of blood.
Convulsions continued so violent, as to require the united strength of
half a dozen persons to keep her in bed. Called in my lamented friend,
Dr. Dabney Lipscomb, who remarked, on his arrival, that " if we did
not get her relieved in a half hour, she must die." So soon as we could
make the necessary arrangements, he administered Chloroform, a few
inhalations of which perfectly controlled the convulsions, so that she
would remain entirely passive in any position in which she was placed.
The head of the child had just fairly entered the superior straight, first
presentation ; soft parts well relaxed ; os uteri well dilated. I intro-
duced the blades of a pair of forceps, and easily delivered the child9
which was of ordinary size and well formed, but had been dead for se-
veral days.

In the course of an hour the effects of the anaesthetic passed off, and
she roused up perfectly bright, clear and collected, but wholly uncon.
scious of any thing which had occurred from the time the convulsions
came on,

Dr. Malum: on Puerperal Convulsions.

595

For some days she complained of muscular soreness. But her re-
covery was rapid and complete, though for some time she supposed her
head to be injured by the effects of the chloroform. She has since had
the misfortune to become a widow, and is now in fine health, and ac-
tively employed in intellectual employments.

Case No. II.

Betsey, mulatto, aged 16; first pregnancy; very fleshy and stout.
June 24th, 1851, called in haste to see her at day-light. She had woke
the family up by the noise made in a fit. When I arrived it had passed
off, though she had not fully returned to a state of consciousness. As
the room was close, had her taken into the fresh air, when she immedi-
ately fell over, in a second convulsion. Bled her freely, and took ad-
vantage of the first practicable opportunity to give a full dose of Oil and
Turpentine. Convulsions continued, and occurred during the forenoon,
whenever there was uterine contraction ; which soon became distinct
and regular, uncontrolled by free bleeding from the arm and from the
temporal artery, or by the effects of Chloroform, Assafoetida, and other
antispasmodics — all of which were freely resorted to. During the af-
ternoon the pains were constant, and the whole system in a state of
spasmodic rigidity, until the delivery of the child, which was of ordin-
ary size and still born. Soon after the delivery the convulsions passed
off, but she lay during the night in a comatose state, breathing stertor-
ously and perfectly insensible.

In the course of the next morning, the cathartic which had been so
aptly given, acted fully and freely, showing that great constipation had
existed. The unfavorable symptoms now gradually, but slowly, subsi-
ded ; on the third day after, consciousness and intellect had returned,
and she continued to improve until her health became fully established.

Case No. III.

Mrs. , daughter of one of our prominent citizens, aged 25 or

26, married about twelve months ; before marriage, large frame and
muscular, dark skin and hair ; during pregnancy she led a very seden-
tary and inactive life ; and increased rapidly and enormously in flesh,
or rather fat ; so much so, that her weight could not have fallen short
of 250 pounds ; previously it would have been about 160.

Late in the evening, on January 10th, 1852, she walked out to where
her husband was, but a short distance, and fell against the root of a
tree, and was discovered to be in a convulsion. She was now suppo-
sed " to be about eight months gone." Her father arrived in a short

590

The New-Orleans Medical and Surgical Journal.

time4 and bled her freely, and the nearest practitioner was sent for. The
convulsions continuing, alternately with coma, I was sent for, a dis-
tance often miles, and arrived about midnight. Found her whole frame
inconstant spasmodic action ; labor progressing slowly ; failed to place
hereunder the influence of Chloroform, so as to control the convulsions;
bleeding had been sufficiently used. It was apparent that immediate
delivery was demanded ; and as she lay extended at full lenth, and
perfectly rigid, with the thighs closely pressed together, we found it
utterly impracticable to get her in a suitable position to introduce the
forceps ; and as the evidences were clear that the child was dead, I
opened the head and delivered the child. It was about the size of the
seventh month. Soon after the spasmodic action subsided, but the co-
ma and stertorous breathing continued, with total insensibility, in which
situation I left her, with her Physician, and returned home early next
morning. Learned that her symptoms continued pretty much the same,
and that she gradually sank and died in the course of some twenty or
thirty hours,

I have no doubt but that an examination, if it could have been had,
would have shown rupture, and effusion on the brain. When the sub-
ject of this report was twelve or thirteen years old, her parents and
friends became very anxious about a troublesome cough, and glandular
swellings about the neck. I was applied to, and put her on the use of
Tr. Iodine and Sassafras tea, which relieved both affections promptly
and finally.

Case No. IV,

Caroline, bright mulatto, aged nineteen ; full habit and fleshy ; first
pregnancy. November 21st, 1852, term of gestation considered com-
plete ; in fine health and spirits during the day and up to bed time.
22d, woke up in the morning totally blind, so as to be unable to find her
clothes, or get out of the room in which she had slept. During the
morning, felt something like labor pains. I was called to see her at 11
o'clock, A. M. Blindness complete ; pupils dilated ; pulse full and
sluggish ; opened a vein in the left arm and took a pint and a half of
blood, when the pulse sank. Gave her a nauseating potion and left
her; returned at 3, P. M. ; had vomited freely; blindness continues;
pulse firm and full, 120 ; skin hot and dry ; opened the temporal artery,
with but little effect, as but a few ounces of blood was obtained ; or-
dered a full dose of oil and turpentine.

At four o'clock was sent for in haste, with the information that she
had a convulsion, which had passed off when I arrived. Symptoms all

Dr. Malone on Puerperal Convulsions.

597

aggravated ; opened a large orifice in the right arm, and took rapidly
from three pints to a half gallon of blood; pulse sank, attended with
full relaxation and profuse perspiration, followed almost instantly by a
violent convulsion, which lasted but a short time, leaving the system
well relaxed. Made a second examination ; soft parts yielding and
very moist, but no dilatation of the os uteri. Lay quietly, apparently
asleep, for an honr, when, becoming restless, and the pulse being soft
and head cool, gave a full dose of morphia.

23d. — Has passed a quiet, comfortable night ; used an enema at
midnight, with but little effect. Blindness continues ; repeated oil and
turpentine. At noon cathartic acted finely ; free from all pain ; pulse
and skin natural ; occiput slightly retracted ; blindness continues. 9
o'clock at night called in ; regular labor pains had come on about 7 ;
skin and pulse natural ; soft parts relaxed ; os uteri well dilated. At
ten o'clock was delivered of a fine living male child. The blindness
continues.

24th. — Passed a very comfortable night ; pulse 88 and soft; skin na-
tural ; intellect clear; appetite good ; unable to distinguish objects or
persons by sight, but can point to the window; says her sight is not as
good as it was before day. Directed counter irritants to the back of the
neck and spine. At 5, P. M., able to distinguish figures, but not the
features of persons. In all other respects doing well.

25th — Morning,— Sight nearly restored ; both mother and child do-
ing well ; discharged.

It had been my intention to close the above cases with some practi-
cal deductions ; but the cases themselves have extended so far, that I
cannot trespass further on your attention.

It will be observed that the anaesthetic influence of Chloroform was
tried in the three first cases. In the first its action was prompt and
salutary. In the second and third, it was found impossible to place the
patients under its influence. In all the cases free bleeding was re-
sorted to ; in the two first, I have no doubt with great benefit ; and in
the fourth, was, I have no doubt, the salvation of both mother and child.
In but one case, the fourth, was the convulsions controlled before the
delivery of the child, except perhaps the first, while under the influence
of Chloroform. Free cathartics, when there was time to act, were de-
cidedly beneficial.

Columbus, Bliss., December, 1852.

598 The New-Orleans Medical and Surgical JoumuL

V.— ANTHRAX OR CARBUNCLE.

BY G. M. WHAKTON, M. D., OF NEW ORLEANS.

1 have the notes of a severe case of Carbuncle, treated by me in
Tuscumbia, Ala., some 16 months since.

The patient was past the meridian of life, and of a constitution much
injured by luxurious and dissipated habit?. The Anthrax was situated
on the back, between the shoulders. It began as a little black, speck-
like pustule, rising on a base of exceedingly disproportioned swelling,
redness and hardness. The pain and itching also appeared greater
than the cause would justify. The patient scratched off the apex of the
pustule, when a small foramen was revealed, filled with a fluid more
like a mixture of serum and pus, than either separately. Other little
ulcers formed in the same manner, each disclosing similar orifices as
soon as they were ruptured. These frequent openings imparted that
resemblance to honey-comh, which those who have seen the disease
have not failed to observe ; and from all the cells alike the whitish, pa-
thognomonic ichor issued slowly, or could be expelled in small quan*
tities by pressure with the fingers. After a while the discharge was
mingled with air, and assumed a very offensive odor. Meantime the
hardness, so noticeable at the commencement, gave place to a softer,
doughy or spongy feel in the centre, but continued about the confines
of the Carbuncle, now embracing an area limited by either scapula on
the right and left, and the cervical and lumbar vertebrae above and be-
low; along these margins the adhesive inflammation forming the ini-
tiatory stage was too recent to have been broken up by subcutaneous
infiltration or sphacelus of the cellular membrane. The redness of the
tumor was exceedingly vivid, and the general symptoms of erysipelas
were unmistakeable. The pain, acute from the beginning, directly
grew intense, being of that fiery, pungent sort, as of a lighted coal upon
the flesh, whence the malady derives its name.

The local disturbance was accompanied with symptoms of constitu*
tional excitement, of a low grade, as is always the case where mortifi-
cation is going on. Thus, a quickened, feeble pulse, diminution of
strength, loss of appetite, headache and nausea, were readily discov-
ered. The patient, on attempting to walk, was compelled to desist,
from faintness ; he labored under constant anxiety, and on several
nights was even delirious.

The time that had elapsed between the appearance of the original
pustule to the present moment, was about ten days, during^vhich inter-
val the patient had used Indian meal cataplasms, and other domestic,
inefficacious topical dressings.

Dr. Wharton on Anthrax or Carbuncle.

599

The indications to be fulfilled were obvious. When a part is mortifying
from inflammation, Hunter says it is the inflammation that must be treated,
notthe mortification. Few cases of sphacelus occur in which tonics, ano-
dynes, and nutritious dietarenot prominent features in the general treat-
ment. The bowels should also be kept relaxed, and the secretions pro-
moted, while cleanliness and pure air should be equally insisted upon. Ac
cordiogly, I administered a dose of hydrarg. chlor. mit., followed by
seidlitz powders. I gave tincture of bark and quinine, and when the
exhaustion and pain were marked, I exhibited ammonia and opium. I
put the patient on a wholesome regimen, and ordered his bed clothes to
be changed often, and his room properly ventilated.

In regard to local means, had I been called early enough, a prompt
application of kali pururn might have destroyed the malignancy of the
Carbuncle, by substituting healthy inflammation and suppuration ; the
diseased portions would have sloughed away, and a cure been effected.
It was larger than a saucer when I first saw it, however, and therefore,
as I conceived, it was too late to try the abortive, caustic mode. The
scalpel was resorted to. I laid the tumefaction deeply open, throughout
its extent, with a crucial incision. It bled freely, nor did I check the
hoemorrhage. I then applied lint dipped in turpentine, and covered the
whole with an emolient poultice. I renewed the former morning and
evening, the latter four or five times a day, the discharges being con-
siderable after the incisions. On the third day, I applied with a feather
diluted aqua ammon. over the part, and then a poultice composed of
crumbed wheat bread or flaxseed meal, stirred up with yeast, previously
spreading a layer of Bals. Peru over the poultice. This last poultice I
sometimes changed for one of carrots, preferring them grated raw and
mixed with lint, to being boiled. These applications cleansed the sore,
corrected its fcetor, and improved its secretions. I was especially
pleased with the good effects of the yeast, which I have heard Prof. Mott
eulogize six or seven years ago.

Under this treatment, the internal addressed to the typhoid con-
dition, the local to the parts neighboring the gangrenous filamen-
tous tissue, my patient rallied promptly. Occasionally, when sloughing
portions showed themselves, and manifestly appeared for excision, I
again used the knife, or scissors. Gradually the erysipelas disappeared,
pus formed, granulations sprouted up in the bottom of the wound, and
the Carbuncle healed like an ordinary phlegmon.

The time elapsing between the discovery of the slight pustule to the
perfect cure of the Anthrax, was exactly one month.

600 The New-Orleans Medical and Surgical Journal.

Carbuncles are usually spoken of under three heads : The common
variety, of which I have endeavored to depict an instance ; the pesti ;
lential ; and the epizootic.

Of the first: Many ordinary boils, which have been picked, bruised,
or otherwise maltreated, and so come to have two or more "heads,"
are confounded with Carbuncles. The true Carbuncle is not so fre-
quently met with; and though it is stated to be generally not fatal, I
have witnessed three deaths, and six cases, in a moderate practice of
five and a half years, in Nashville, Tennessee, and North Alabama.
In one of these fatal cases, the Carbuncle was located on the neck, and
the patient died from effusion upon the brain and spinal marrow ; in
others, the back was the seat of the inflammation. The back, the neck,
the nates, more rarely the cheek, and very seldom the abdomen, are the
chief seats of the disease ; and the fatality is proportioned to the com-
plication of the brain and spinal marrow. Sometimes the inflamma-
tion becomes so extensive, and the constitutional irritation so great, as
to occasion prostration, exhaustion and death, without a complication of
the organs mentioned.

Of the second: Pestilential Carbuncle prevails in Oriental countries,
and consists of a rapid, acute inflammation, and enlargement of the se-
creting and lymphatic glands. It is the pathognomonic symptom of the
plague, concerning which see Russell, and others.

Of the third : Epizootic Carbuncle, equinia, pharcy, or glanders, is
a disease originating with animals, but communicable to man. I have
seen horses and oxen affected with it. It is primarily an affection of the
• mucous membrane of the nose, antrum and fauces, with enormous sympa
thetic enlargements of the cervical glands, etc. I have never seen it
except in horses and oxen. It is well described in books on farriery
and the diseases of cattle.

VI. — VERATRUM VIRIDE, &c.

Abbeyville Court House, South Carolina, )
November 18, 1852. \

A. Hester, M. D.

Dear Sir — We present the following cases as they oucurred, with-
out comment :

CASE FIRST.

Mr. G., about thirty-five years of age, robust frame, inclining to
corpulency; health good, with a slight tendency to acidity of the sto-
mach after taking a full meal. Had eaten nothing since morning till

Dr. Norwood on Vemtruty Viride,

aiglit o'clock at night. About one hour after he had supped, or rather
dined and supped heartily on bacon and crout, followed with bread and
milk, he was suddenly seized with a most intensely agonizing pain in
the glans penis. It was so violent and unexpected, that it created quite
an alarm in himself and family, as to what might be the result. But
relief was obtained so soon as the stomach was emptied of its undi-
gested contents.

He was repeatedly attacked in the same manner after fasting and
eating freely of strong food ; but relief always followed the unloading
the stomach of its contents. Blue pill, columbo, sup. carb, soda and
dieting corrected the condition and broke up the disease.

CASE SECOND.

Mr. R., about twenty-one years of age, of general good health. In
the habit of turkey hunting; going out before day and fasting ; eating
heartily after unusual fasting and exercising. He was about two hours
after attacked with a violent pain in the sphincter ani ; so violent was
the pain, that he had taken more than two hundred drops of laudanum
in a very short space of time, before wTe visited him, and the relief was
so slight, that he begged to have the vial containing the laudanum
handed to him. Relieved by emptying the stomach of its contents.
We would state that this turkey hunting takes place in the winter sea-
son, and those engaged in it sit and stand for hours on the cold and
damp ground, watching for the game. He had repeated attacks after
fasting, exercising and eating freely. On several occasions there was
acidity of the stomach. Throwing off the contents of his stomach was
followed with relief. Blue pill, ginger, precipt., carb. iron, wrought a
perfect cure.

CASE THIRD.

Dr. G., about fifty years of age, of full habit, good health, and gen-
erous liver. Had been complaining for a time of slight pains and ten-
derness in the large tendons, near their insertion into the occiput ; was
troubled a few days after dining with slight giddiness and sensation of
nausea and sickness at the stomach, which soon passed off without in-
convenience. About the third day after his feeling these sensations of
nausea, sickness, etc., he dined unusually hearty. About two hours af-
ter, he was sudden^- seized with the most alarming and intense vertigo,
followed with nausea and vomiting. The sensation on moving his
head was indescribably unpleasant, and unaccompanied with any pain.
The least jar or motion of the head was intolerable, and threatened
immediate dissolution. There was not the least disturbance of the

602 The New-Orleans Medical and Surgical Journal.

intellectual faculties at any time. During the continuance of the pa-
roxysm, there was an absence of all pain and tenderness in the tendons
formerly affected. But this tenderness, pain and uneasiness were al-
ways felt and complained of after relieffrom the vertigo was obtained.
Being of full and phlethoric habit, he was bled and cupped freely9
dieted, blistered, and took blue pill. Recovering his health and vigor,
and giving way to his desire to indulge his appetite, he was seized
with a second attack in about eight months. Identically the same symp«
toms, but being less violent, under the same course of treatment he
rapidly recovered his usual health and vigor.

About two months after his second attack, he indulged in a liberal
quantity of meats at supper ; before rising from the table, psychology
was broached as a topic of discussion, as it was exciting the attention
even of some of the literati in that vicinity. While the discussion was
progressing, he felt a slight pain in the shoulder-joint, and jestingly
proposed himself as a fit subject, or rather a willing subject, to test the
merits of the mighty claims of this then lion of the day. The pain
increasing, and feeling at the same time a pain in the region of the
heart, notwithstanding their manipulations and belief in the powers of
points, he at length observed to those magic workers, that his case
was growing serious, and that something more efficient must be tried to
arrest the then violent pain. In three hours from his first feeling of
pain, he was no more— he was dead !

We were absent, and did not see him in this last and fatal attack.
What would have been the effect of an emetic to relieve the loaded
stomach 1

In the first two cases, if the pain had fallen on the heart and not on
the penis and sphincter ani, would it have proved fatal 1 Might not the
throwing off the contents of the stomach, by an emetic, have afforded
relief, even if the pain had fallen on that vital organ in the first two
cases?

We will, in conclusion, add a few remarks on Veratrum Viride, as
many of the numerous readers of your Journal have written to us on
that subject since the notice of it in your September number. We will
state for the information of those of the Profession who have not seen
the original article, that every property and power Wd have claimed for
it, have been fully confirmed and established by other and much abler
pens than ours. Dr. Summer of South Carolina, has published a val-
uable article, fully sustaining its claims in Pneumonia. Dr. Robert of
Alabama, has given the public an article still further setting forth its

Dr. Norwood on Veratrum Viride, <fyc. (303

undoubted powers in the same and a few other diseases. Dr. E. L.
Antony of Burke county, Georgia, has given a clear and graphic ac-
count of its varied and wonderful powers in the successful treatment of
numerous diseases, in their most alarming stages, such as Pneumonia,
Puerperal Fever, etc. In addition, he has reported to us from a friend,
two wonderful cures of Chorea. The number and variety of cases re-
ported by him, if there was no other evidence at hand, would entitle it
to all the encomiums we have lavished upon it in our efforts to call at-
tention to one of the most valuable remedial agents known in the
wide universe of nature, and should enlist at least sufficient curiosity to
call for a trial of its virtues.

Frost of Charleston, Professor of Materia Medica, has conclusively
established, or rather sustained and confirmed the claims set up for it in
an able and chaste article, which he read before the Medical Society.
We had hoped before this to have received a copy of said article. Dr.
Wilburn of Alabama, has paid due honor to its powers in Typhoid
Fever, and he has manifested a tact in managing that disease that we
rarely see exhibited to the world. Dr, Branch of South Carolina, and
Dr. Blackburn of Georgia, have stood forth as champions in defence
of its unquestionably varied and astonishing powers, sustained by their
combined experience, which may be found in the Charleston Journal.
Dr. Cooper of Georgia, a man who stands deservedly high in his pro-
fession, and who, if he should live, will do honor to the noble profes-
sion, brought to the notice of the State Medical Society, its valuable
properties, which can be seen in the transactions of that body. It
would be a waste of time for us to press the nature of this agent fur-
ther.

When we published our first article in June, 1850, in the Medical
Journal published in Augusta, Georgia, giving the recipe for making
the tincture, and the method of using it, we supposed that the druggists
would have supplied the profession with an abundance of the article ;
but they, like many others, looked on it as a humbug, and the time
for digging the root has been suffered to pass till next summer, as
it is early cut down by the frost. On account of the numerous demands
or requests made for the preparation, we have been at great pains to
secure a pure article, and to those who may wish it, we will send a suffi-
ciency of the root to treat over one hundred cases with the recipe, and
a card of directions for using. Those who took the Journal have al-
ready the recipe and method of using, and the recipe will appear to-
gether with the manner of using, in an article sent in already for pub-
lication in December ,

(304

The New-Orleans Medical and Surgical Journal.

We here annex a number of diseases in which the above may be
used with marked success : Typhoid fever, puerperal fever, scarlet fe-
ver, pneumonia typhoides, hooping cough and croup with febrile, excite-
ment, asthma, rheumatism, convulsions with high febrile excitement,
inflamed breasts of lying-in women, mumps, where there has been
metastasis to the testicle, inflammation of the brain, palpitation of the
heart, etc.

The numerous calls from your State, Mr. Editor, and from Missis-
sippi, Alabama, Texas and Arkansas, where your Journal widely circu-
lates, induced us to send in the above. We have been written to, to
put a stop to the sale of an impure and inert article. Why, my dear
sir, we hav no more control over it than any other Physician in the
United States. Any person who will take the Medical Journal pub-
lished at Augusta, will find that we have not only given the recipe, etc.,
but that we have urged the profession to test the powers — yea further,
we have staked our reputation as a medical man, and have urged the
rial, and await the decision of that enlightened and honorable body.
We had no idea of supplying the profession in the limited manner we
are now doing, but from the numerous requests made, and from an un-
fortunate necessity that has been pressing on us for many years, which
we would gladly be rid of. The druggists will surely by next season
make arrangements to supply the demand, as we shall no longer keep
it after disposing of the lot on hand.

Since visiting your city, I have intended to notice its great facilities
for medical education, but will omit it till my next.

IV._ON INFLAMMATION OF THE NOSTRILS.

BY J. HANCOCK DOUGLAS, ftt. D., OF NEW ORLEANS.

The simple affection known as " cold in the head," or more properly
as inflammation of the nostrils, coryza, or gravedo, the beginning of
so many ills to mankind, deserves more attention than is usually given
to it. Coming upon us unawares, it draws in its train the whole cata-
logue of sorrows and maladies which spring from serious lesions of the
lungs. Attacking the very commencement of that expansive tissue, the
mucous membrane, it is easily carried, by continuity, throughout its
whole extent, unless appropriate means are adopted to check its pro-
gress. Oftentimes, running out its course unattended, without serious
result, it yet occasionally terminates in those dire forms of disease

Dr. Douglas on Inflammation of the Nostrils.

G05

which decimates childhood and old age, and arouses the symptoms of
that terrible affection, the scourge of the civilized world.

There are two forms of -inflammation of the nostrils ; the acute form,
known as "cold in the head ;" and the chronic form, or catarrh in the
head ; both affecting the same tissues, and having the same general
laws as to their seat, origin, progress and treatment.

The acute form I shall not describe, but merely give the treatment,
which I have found as almost invariably checking it, if used in the
first few hours of its invasion. The vapor of laudanum, of chloroform,
of camphor, of various tisans, have been used with great benefit, in
insufflation, to calm the local symptoms, but none have succeeded as
well with me, in producing a permanent effect, as pure laudanum itself.
The local difficulty seems to yield immediately ; the sense of tenseness
across the brows, the tearful eyes, the difficulty of breathing through
one or both nostrils, the constant attention to the removal of mucus
from the anterior nares, and in fine, all the general symptoms are re-
lieved.

I direct the laudanum to be used as follows : Placing a small quan-
tity, as a quarter to half a tea spoonful, in the palm of one hand, to
snuff it up through the nostril corresponding to that side, closing the
opposite nostril with the other hand, and vice versa, allowing the laud-
anum to reach the throat, but not swallowing it. It is also well to drive
the fluid as far up towards the frontal sinuses as possible, by a sudden
blowing through the nose. This may be repeated, if necessary, once
or twice, at intervals of two or three hours, but I have seldom found
it necessary to repeat it more than twice. The exhibition of a brisk
cathartic after it, will tend to break up the severest coryzas.

This simple remedy is within the reach of every one, and if used
early, will save much suffering from the disease, and prevent the dan-
gerous sequela?.

The chronic form of this disease may arise from the acute, by its
continuance or frequent repetition, or from the irritation of any foreign
body in those passages ; such as polypi, impacted mucus, grain, persim-
mon seed, &c. Although not as dangerous, yet there is not a single
disease of the mucous membrane so difficult to relieve, or which baf-
fles so steadily the skill of the medical attendant, as that of chronic in-
flammation of the nostrils.

Resulting from the acute form, it may be characterized for a longtime
by a continued irritation of the nasal membrane, producing a flow of a
thin, white, glairy mucus, which is only disagreeable from its quantity.
This irritation, however, becoming aggravated, may result in a thick-

606

The New-Orleans Medical and Surgical Journal.

ened, hypertrophied condition of the mucous membrane, pouring off an
excessive quantity of a thick, muco-purulent secretion, obstructing the
passage of air, destroying the sense of smell, partially that of taste, and
making the patient disagreeable to himself, if not to others, by his con-
stant efforts to relieve the organs of the mucus, by the drawing of air
through the nostrils. This condition continuing, the parts become
more and more affected by the irritating action of the secretions, or by
their accumulating in the sinuses, where they dry, and act as foreign
bodies, causing a disintegration of the mucous surfaces, and eventually
produce that offensive and dangerous form known as ozsena*

In the chronic form of inflammation of the nostrils, there is little or
no fever, but it has distinctive characters, a certain physiognomy which
is peculiar to it. The voice is changed, having a nasal tone, the alsd
of the nose are drawn up, giving a scornful, cynical expression to the
face ; the eyes are often tearful ; and the sclerotic coat of the inferior
lid especially, is slightly congested, while the loose cellular tissue below
the eyes seems puffed up ; and even in some cases as if there was fluid
infiltration there. The patient complains of a constant dull pain over
the brows, corresponding to the region of the frontal sinuses, and in
severe cases, the cheek bones are designated as aching points. The
antrums are here affected, and the surface of the membrane involved
being so extensive, the expectoration is so much the greater. The re-
spiration is impeded or altogether suspended through the nasal passa-
ges, obliging the patient to breathe continually through his mouth, re-
quiring it consequently to remain open, with the chin dropped, which,
in young subjects, sometimes gives an elongation to the lower jaw,
and produces no slight deformity. This is particularly observable in
cases where enlarged tonsils block up the posterior nares, nor does
this complication limit its interruption of healthy respiration here, but
interferes with the proper expansion of chest, and produces deformity
there, as observed by M. Robert, in his article on Deformity resulting
from Enlarged Tonsils.

The profuse secretion passing over the throat irritates it, and extends
the disease, while, more or less being carried into the stomach, deranges
the digestive functions, establishes dyspepsia, and thus breaks down the
hardiest constitution ; or else from some hereditary predisposition, it
directs its course towards the larynx, and arouses the same condition
in the passages more directly concerned in the act of respiration.

The examination of the pharynx and posterior nares, will reveal that
condition of parts which favors the excessive secretion of muco-puru-

Dr. Douglas on Inflammation of the Nostrils,

(507

lent matter. If the irritation has extended much into the pharynx, the
arches of the palate, as well as the posterior wall of the pharynx, will
be found thickened, the whole throat much tumefied and smooth, or the
follicules will be seen enlarged, hypertrophied and irritated, presenting
a granular appearance, as in granular lids, or the like form of disease of
the neck of the womb, while the mucous membrane itself is deprived
of its epithelium. Sometimes the parts are bathed with a thick, yellow
secretion, which may be seen running down from the posterior nares,
and forming, as is sometimes the case, a complete covering to the pha-
ryngeal membrane, or it is again turned back in the centre, by the respi-
ration, and forms a crescentic shape, the arms dipping down into the
fossae on each side of the larynx. The severe cases, from the extent
of the disease, and the acrid, irritating character of the secretion, are
accompanied with hypertrophy of the tonsils, a patulous condition of
the uvula, and a relaxation of the whole of the soft palate. The ante-
rior nares examined by means of a curved forceps, or the ordinary ear
speculum, presents a similar tumefaction and hypertrophied condition of
the pituitous membrane, sometimes resembling oedema.

Considering the disease as a local one, our plan of treatment is mostly
local, and applied directly to the part affected. This is done in two
ways. Either by sternutatories or injections — the latter of which we
prefer. When, however, there are complications in the disturbance of
other functions of the economy, measures should be adopted for the
relief of those complications. The local treatment needs much perse-
verance, for the extensive surface often affected, and the general long
standing character of the disease, requires long attention and thorough
application of the local remedies.

The sternutatories have usually in their combination, upon which
their efficacy depends, some form of the mercurials, and the nitrate of
silver ; while the injections are solutions of zinc, nitrate of silver, cre-
osote, chloride of lime, weakened solutions of LugoPs Solution, and
Fowler's Solution, &c. The Iodide of Potassium should be adminis-
tered internally, and after an alterative has been produced by this re"
medy, the mineral acids and tonics, such as the Mur. Tine, of Iron,
Iodide of Iron, &c, should be given.

In the treatment of these cases, we have found no application so ge-
nerally efficacious as a solution of the nitrate of silver, which at first
should be made weak, and gradually increased in strength as the parts,
become accustomed to the application. Our method of introducing these
injections is by the posterior nares, by means of a small syringe, with,
a long slender beak, bent within an half inch of the extremity, at tk

608 The New -Orleans Medical and Surgical Journal.

right angle, which admits the passage of it behind the uvula, and by a
forcible expulsion of the liquid in the syringe, it can be thrown high up
into the nares, even into the frontal sinuses, and the patient by immedi-
ately bending his head forward, will allow the fluid to come out of the
nostrils. He can also favor the entrance of it into the frontal sinus by
suddenly blowing through the nostrils, in a sort of sniffling manner. It
is important to have the fluid touch all parts of the affected membrane
possible, so that if both sides of the nostrils are diseased, it will be ne-
cessary to take each one separately, unless the operator acquires the
facility to manipulate the instrument, so as to do it at one and the same
time. The injection by the posterior nares has seemed to me more
certain than that by the nostrils, permitting the fluid to reach a greater
surface of membrane, and not subjecting the patient to a sudden flow
of the injected fluid into the throat and mouth, causing occasional stran-
gulation, and always a disagreeable sensation. The application even
with the mildest strength, is at first exceedingly unpleasant, and some-
times painful, as it would be with pure water, but each succeeding ap.
plication becomes less so. The strength we have used has varied from
five grains to twenty of the crystalized nitrate, to an ounce of water.
Solutions of other preparations can be used in the same way, but when
there exists any abrasion of the membrane, or slight ulceration, within
sight, a stronger solution can be applied by means of a sponge-armed
probang.

In those severe forms of ozsena, with ulceration and loss of some
portion of the soft palate and walls of the pharynx, a solution varying
from forty grains to a saturated solution, should be used, by the probang.
This strong solution is far more curative than the caustic, which often-
times only seems to increase the difficulty. The application may be
made every day, or every second or third day, as occasion may require.

Dr. Riddell on the Plants of the South West. 609

VIII.— BOTANICAL CONTRIBUTIONS.
New and hitherto unpublished Plants of the South West, mostly indige-
nous in Louisiana, and referred to by name in the " Catologus Florm
Ludoviciana," published in the New Orleans Medical and Surgical
Journal, Vol. VIII., pages 743 to 764, May No,, 1852 ; and embra.
ced in the MS. " Plants of Louisiana," illustrated by specimens and
drawings, deposited in the Smithsonian Institution in 1851.

BY J. L. RIDDELL, M. D.
Prof. Chemistry in Med. Dep. Univ. La.

Melothria punctata. Leaves small, deeply lobed, papillose punctate*
hispid ; pedicels much shorter than the leaves. June. Dry Prairies
of Opelousas, Carpenter. Found also in Texas in 1839. Plants of
La. No. 546. Natural order, Cucurbitaceae.

Cucumis odoratissimus, Carpenter, MSS. Whole plant strigosely pu-
bescent ; leaves cordate, slightly 5-lobed, lobes rounded, serrulate ; fruit
from one and a half to three inches in diameter, subspherical, pubescent
before maturity and longitudinally marked with alternate bands of green
and whitish ; which when mature become pale green and yellow ; fra-
grant. Flowers from May to September. East Feliciana, La. Car-
penter. Plants of La, No. 554. Natural order Cucurbitaceae.

Campanula Ludoviciana. Lower leaves orbicular, spatulate, petioled;
upper ones ovate, half clasping, crenate, undulated on the sides ; stem
branching ; flowers single, blue. Plant eight to twelve inches high.
Flowers in Ap. May. Fields about New Orleans. Resembles C.
amplexicaulis. Plants of La. No. 1018. Natural order Campanu-
laceae.

Lysimachia procumbens. Leaves opposite, petioled, without dots,
entire, acute ; lower ones ovate, rounded at the base, on petioles one
half their length ; upper ones lance-ovate, on shorter narrowly mar-
gined petioles ; flowers yellow, very small, about one third to one half
the size of those of the L. lanceolata, axillary, on opposite peduncles
rather longer than the leaves; segments of the corolla rounded, crenate,
mucronate, about as long as the calyx ; stem with attenuated branches
one to four feet long, weak, procumbent, resting on small bushes, qua-
drangular with the faces grooved and the angles flattened. Full sized
leaves from one to one and a half inches long ; flowers from May to
August. Damp pine woods Madisonville, Swamps, lower La. Plants
La. No. 1071. Natural order Primulaceae.

Lysimachia Carpenterii. Leaves opposite, entire, without dots, lin-

610 The New-Orleans Medical and Surgical Journal.

ear-lanceolate and oblanceolate, tapering and acute at both ends, oil
short ciliated petioles ; flowers yellow, as large as those of L. lanceolata?
generally in fours at the summit, on peduncles a fourth shorter than the
leaves ; sepals lanceolate, acuminate ; corolla rather longer than the
calyx ; stem simple, six to eight inches high, slightly sulcate. Leaves
near two inches long. Flowers April to June. Open pine woods, East
Feliciana, Carpenter. Plants of La. No. 1072. Natural order Pri-
mulacese,

Plantago Ludoviciana. Leaves lance-linear and linear, acutish, at-
tenuated into petioles, usually with several irregular, prominent, lateral
teeth, pubescent towards the base ; scapes numerous, pubescent, sulcate,
nearly twice as long as the leaves ; spikes long and loose, the flowers
usually separate; bracts ovate, acute, with membraneous margin, longer
than the membraneous calyx, shorter than the matured capsule ; three
to six inches high. Annual. New Orleans. Differs from P. pusilla,
Nutt., to which it is closely allied, in its greater size, toothed leaves,
and more elongated, sparsely flowered spike. Plants of La. No. 1084.
Natural order Plantaginacese,

Dicliptera Halei. Leaves short petioled, slightly pubescent ; margin
repand, dentate or entire ; lower leaves obovate, spatulate, obtuse ;
middle ones oval and lance-oval, near three inches long by more than
one broad, acuminate, attenuate at base ; upper ones ovate and lance-
ovate ; flowers six to eight in a compact, mostly terminal spike or spikes,
(sometimes solitary in the axils of the leaves) mostly sessile in the axils
of small bractcate leaves, the lowest pair of which are ovate, acute, sub-
petioled; the others obovate, obtuse, rnucronate, sessile; all of them
ciliate ; bracts two at the base of each calyx, linear, acute, cil-
iate, nearly equal, almost as long as the tube of the corolla ; calyx 5
parted; divisions linear; corolla pale red almost white ; limb resupin-
ate ; upper lip ovate, entire or slightly emarginate ; lower lip 3-lobed ;
pod ovate, compressed, pointed with the persistent style, loculicidal, con-
taining four irregularly lenticular seeds, each one eighth of an inch in
diameter. Stem simple or branched, about six to twelve inches high.
Flowers from June to September. Shady lands, Rapides, Hale. Thomp-
son's Creek, Feliciana, Carpenter. I have specimens from Alabama,
collected by S. B. Buckley. Plants of La. Natural order Acan*
thacese.

Physalis Carpenterii. Leaves long petiolated, obliquely or unevenly
cordate, ovate, acuminate ; margin repand, undulate ; flowers small, on
pedicels near half an inch long, in axillary fascicles of three to six ;

Dr. Riddell on the Plants of the South West.

611

corolla pale yellow, with lurid crimson spots at the bottom. Herbace-
ous, branching, three to four feet high; larger leaves two to three
inches, on petioles two inches long. Shady low lands, and thick woods,
flowering in June. East Feliciana, Carpenter. Plants of La. No.
1312. Natural order Solanacese.

Polygonum Opelousanum. Leaves sessile upon the sheathing stip-
ules, narrowly lance-linear (larger ones two to three inches long) sub-
acute, entire ; margin subrevolute, margin and midrib armed with ap-
pressed setes ; stipules hirsute, ciliate with cilise as long as the tube of
the stipule ; spikes slender, six to eight on each branch in a terminal
cluster ; flowers not much crowded, embraced below in an outer ciliate
bract resembling the stipules, and an inner membranaceous bracteose
structure with four gland bearing filaments ; corolla 0 ; calyx deeply
5>parted ; divisions ovate, white with a tinge of red ; nut triangular,
shining black; near half a linejn diameter ; stamens eight; styles three.
Stem ascending, ramose, two feet high. Low prairies of Opelousas>
flowering in June and July. Specimens collected by Carpenter. Plants
of La* No. 1431. Natural order Polygonaceeeo

Polygonum geniculatum. Leaves linear-lanceolate, often falcate'
(larger ones five inches long by two thirds of an inch broad) entire*
acute, partly amplexicaul, sub-glabrous ; edge armed with numerous
very short stiff setae ; midrib with minute recurved prickles below; co-
rolla 0 ; calyx 5-parted,F'persistent, red at the tip, embracing the seed ;
stamens mostly five ?; styles three ; nut broad ovoid, obtusely triangu-
lar, wine-colored and shining when ripe, about a line in diameter ; flow-
ers on short pedicels, (the latter embraced in ragged membraneous, sub-
hirsute bracts) three to six together in a short lax spike, — and several
of these spikes arranged on long dichotomously branched peduncles to
form an axillary cyme ; stem sub-scandent, two to three feet, geniculate
or zigzag, branching above, deeply sulcate, armed with minute recurved
prickles, which are most numerous at the angles or base of the leaves,
glandularly setose above ; stipules membranaceous, setose at the end.
Marshy prairies on the Tchefuncte river, opposite Madisonville, and
about lake Pontchartrain, flowering from July to September. Plants
of La. No. 1432. Natural order Polygonaeese.

Eriogonum setaceum. Leaves crowded near base or root, densely
tomentose on both sides, white becoming cinereous, oval, entire, obtuse;
(medium size four lines by two) upper ones on petioles of their own
length; lower ones sub-spatulate on still longer petioles ; stems densely
tomentose, caespitose, many arising from the same large, dark, woody

612 The New Orleans Medical and Surgical Journal.

perennial root, or sometimes from a sub-repent main stem, clothed with
leaves two or three inches high, mostly simple ; general peduncle or
scape naked, glabrous, pale purple, undivided for two or three inches,
then dichtomously forked to produce a loose corymb of twelve to twenty
involucres ; each joint is enveloped by a toothed involucre, and sends
out a flower bearing pedicel besides the two branches ; pedicels from
a quarter to an inch long, setaceous, crowned by a cyathiform 5-toothed
green involucre bearing ten to twenty flowers ; sepals white, six ; the
three outer broad, nearly circular, retuse, sub-plaited ; the inner ones
narrow lance-oblong ; styles three ; stamems variable, seven to nine
observed ; germ ovoid triangular. On dry granular quartz rocks, Ka-
olin creek, between the Piedernalis and San Saba rivers, Texas, (No-
vember, 1839). Grows six to twelve inches high. Natural order Po-
lygonacese.

Acalypha Virginica, Linn. Natural order Euphorbiaceae. This
plant varies so much with us, that it might perhaps appropriately be
subdivided into several species. We have the following and interme-
diate forms. I set them down as varieties, although considering the
convenience of the dual method of naming, I would prefer to consider
them as species.

Var. rhombifolia. (A. Caroliniana, Michaux-) Leaves rhomb-ovate,
wedge-form at base, obtusely crenate, serrate, nearly globrous, sub-
acute ; radical leaves shorter than the petioles ; (two and a half by one
and a quarter inches) bracts large, gashed more than half way to the
base. Flowers June to September. Woods, etc.

Var. intermedia. Leaves ovate, obtusish at base and apex, slightly
crenate-serrate ; medial leaves rather shorter than the petioles, (one
and a half by three quarter inches) sparingly pilose ; bracts of medium
size, gashed rather less than half way down. Jul. Sept. Flat, open
woods.

Var. ovalifolia. Leaves oval and oblong oval, obtuse, slightly cre-
nate, almost glabrous ; medial leaves five times as long as the petioles;
bracts small, gashed, less than quarter the way to the base. August.
Fields. New Orleans.

Var. gracilens, (embraced in A. gracilens. A. Gray Bot. Northern
States, p. 408 ; probably very near the original A. Virginica, Linn.)
Leaves lanceolate and oblong lanceolate, obtusish, acute at base ;
slightly crenate, sub-pilose ; medial leaves about six times as long as
the petioles ; (one and a half by one third inches) ; bracts of medium

Dr. Riddell on the Plants of the South West.

613

size, gashed about quarter the way down. Jul. Sept. Sandy pine
woods, La.

Var. ramosa. Very branching ; leaves lance-linear and oblong-
linear ; apex acutish ; base obtusish, pilose ; medial leaves eight times
as long as the petioles ; one by one sixth inches ) bracts large, gashed
nearly one third the way down. Jul. September. Dry pine woods,
Louisiana.

Var. Texana. Very hardy and branching ; leaves oblong-linear, ob-
tusish, mostly entire, mealy tomentose ; medial leaves nearly ten times
as long as the petioles ; (one and a quarter inches) stem almost frutes-
cent, eight to twelve inches high ; bracts small, crenate-serrate ; divi-
sions extending about one eighth or one tenth the way to the base.
August and September. Dry sandy prairies, Texas and Western Loui-
siana.

Remark. The leaves of the foregoing varieties are all entire
near the base ; the indentations, if any, occurring in the anterior
part.

Acalypha ovata. Leaves on short petioles, (one twelfth to one eighth
of an inch long) ovate, acutish, rounded obtuse at base, serrate, (me-
dium length half an inch, larger ones one and a quarter inch) sub-pu-
bescent ; stem terete, not furrowed, sub-pubescent, somewhat branched
and fruticose ; styles three, red. cut- fringed, persistent ; germ consisting
of three globular carpels; pilose above; bracts small, faintly embracing
the germ, convex without, pilose, serrately gashed about one-third the
way down ; root black and woody, perennial. Grows six to ten inches
high, on the high prairies of the Camanche country, Texas. (Novem-
ber, 1839.)

This species is a true congener with A. Caroliniana, Walter (Not
Michaux). Natural order Euphorbiaceae.

Quercus Carpenterii. Leaves short petioled, (near quarter of an
inch) cinerous tomentose beneath, smooth aud shining above ; outline
oblong, (larger ones one and a half by four inches) with three to five
shallow, irregular sinuses on each side, having the small lobes or rather
large teeth acute and awned ; acorn nearly sessile ; nut globose, near
half an inch in diameter, half embraced in the hemispherical capsule.
This oak was queried in the herbarium of the late W. M. Carpenter,
as a variety of Quercus falcata. A large tree, growing around the
prairies of Feliciana, La. Carp. Plants of La. No. 1552. Natural or-
der Cupulifera?,

614 The New-Orleans Medical and Surgical Journal.

Quercus Peckiana. (In memory of the late Dr. Clarendon Peck of
Louisiana, a zealous student in botany.) Leaves on short petioles (one
sixth of an inch) cinereous downy beneath, glabrous shining above, at the
base sometimes obtuse, most frequently acute, diverse in form and out.
line, viz : 1st, obovate or oblong or oblanceolate, entire with a terminal
awn, with margin plane or wavy ; 2d, with one to three rounded or
acute small lobes or projections from one or both margins. Average
size of leaves one and a half by three and a half inches. Prairies
of Middle Louisiana. Fruit not seen. Plants of La. No. 1553.

Quercus Andromeda. Leaves sub-sessile, acute, sub-mucronate, ob-
lanceolate, tapering at base, entire, thick coriaceous, smooth shining
above, dens ely tomentose cinerous below, average length under two
inches ; midrib depress ed above, very prominent below; margin revo-
lute ; acorn sessile, very small? (not mature in my specimens) branch-
lets glandular punctate. Amongst Carpenter's latest Louisiana collec-
tions. Plants of La. No. 1554.

Quercus rhombifolia. Leaves short petioled (one eighth to half inch)
acute at the base, rusty tomentose beneath, smooth above ; prevailing
outline rhomboid, though variable, viz : 1st, obovate, entire, acute, mu-
cronate ; 2d, broad rhomboid, mucronate, with the lateral corners
rounded ; 3d, with a terminal, and on each side a lateral lobe, all
awned or mucronate, margin toward the base repand ; acorn on a
short pedicel, (not mature in my specimens, said by Dr. Josiah Hale to
be very similar to the acorn of Quercus tinctoria, Bartram). Tall oak
tree, two feet in diameter, Alexandria, La. Dr. Hale, by whom it was
first detected. Plants of La. No. 1555.

Quercus bumeliaefolia. Leaves very short petioled, (eighth of an
inch) acute at base; apex mostly rounded obtusish, somewhat coriaceous,
with tufts of cinereous pubescence often beneath in the axils of the vena-
tion, obovate and oblanceolate, seldom lance-ovate ; margin usually
wavy repand ; acorn half an inch in diameter ; nut ovoid, one third
embraced in the capsule. Leaves resembling those of Bumelia tenax.
Small tree, thirty to forty feet high. Alluvial lands, Red river eountry,
Hale. Plants of La. No. 1556.

Urtica Aureliana. Leaves opposite, rather long petioled ; lowest ones
orbicular, subreniform, crenate, with regular rounded projections ; up-
permost ones ovate and lanceolate, coarsely crenate dentate ; flowers
green or purple and green, in globular clusters ; two clusters in the
axil of each leaf, on peduncles near one sixth as long as the petiole ;
monceeeous ; staminate flowers intermingled with pistillate ones; sta-

Dr. Riddell on the Plants of the South West.

615

mens uncoiling and bursting elastically ; perianth four rounded lobes,
half as long as the stamens ; pistillate flowers with two large obovate
sepals, alternating with two very small ones ; nut compressed, ovate,
shining. Roots annual, whole plant sparingly hispid and armed with
most virulent white stings arising from black glands. Stem branching
near the ground, one to two feet high. Fence corners, woods, etc.,
about New Orleans, and elsewhere, La. Flowers from February to
April.

The Urtica purpurascens, Nutt., and the U. verna, Raf., are both
closely allied species, all bearing a near affinity to the stinging nettle,
U. urens, Linn. Plants of La. No. 1582. Natural] order Urti-
cacese.

Potamogeton fulvus. Leaves all submersed, thin membranaceous,
broad deltoid cordate, (one third of an inch long and rather less in
width) amplexicaul, embracing when single more than three fourths of
the stem, half clasping at the branches where they are opposite, obtus-
ish, 7-nerved ; margin repand, crisped and wavy ; axils setose ; pedun-
cles long (an inch or so) club shaped ; spikes four to eight flowered
ovaloid ; nutlet obliquely obovoid, rounded, sub-compressed, minutely
subverrucose, about one sixteenth of an inch in diameter, with an ex-
centrically placed short obtuse beak ; stem slender, (the thirtieth of an
inch in thickness) branching one to three feet long. Whole plant of a
more or less dark yellowish hue, which in the leaves becomes olive
green. Shallow margin of Lake Pontchartrain and elsewhere, La.
Flowers from June to September. Allied to P. perfoliatus, Linn.,
though quite distinct. Plants of La. No. 1617. Natural order Nai-
daceae.

Sagittaria gigantea. Leaves oblong-lanceolate, acute, about 9-nerved;
blade sometimes two feet long by six or eight inches wide, standing,
with the branching scape three to six feet high ; flowers large, white,
resembling those of S. rigida, Pursh. Swamps, New Orleans, and in-
undated margin of Lake Pontchartrain. Flowers from June to Sept.
Plants of La. No. 1625. Natural order Alismacese.

Sagittaria paradoxa, Carpenter MS. with specimens in his herbarium,
which is now incorporated with the herbarium of the author. Leaves
all radical, numerous; the outer ones membranaceous, striate, grass-like,
six to eight inches long, eight lines wide, of equal width throughout the
whole length to within about an inch of the point, then tapering to form
an acute, often a linear acumination, sessile, clasping at base ; inner
leaves linear, with long filiform terminations, (eighteen to twenty-four

616 The New-Orleans Medical and Surgical Journal.

inches long) sheathing at base ; scape naked, fourteen to sixteen inches
high ; flowers small, generally in 3-flowered whorls, on pedicels six to
ten lines long, ten to fifteen flowers forming a simple raceme ; bracts
broad ovate, obtuse. Muddy ponds, Buhler's Plain, West Baton Rouge.
Flowers from April to June. Plants of La. No. 1626. Natural order
AlismacefE.

Adiantum australe. Csespitose ; frond decompound and supra-decom-
pound, outline lanceolate ; pinnules short petioled, acute and wedge-
form at base, of a lively green color, terminating in rounded serrulate
sori-bearing lobes. The stalk (including the whole frond) is from six
to thirty inches in length, shining, of a wine-color, nearly black when
old ; usually more or less pendulous from the side of limestone cliffs,
adjacent to springs or streams of water. Western Texas, (Sept. 1839)
Alabama, Florida.

Compared with European specimens of A. Capillus-Veneris, which
it closely resembles, it seems much larger, and the pinnules more lobed.
Plants of La. No. 1775. Natural order Filices.

Pteris zygophylla. Frond glabrous, supra-decompound, outline tri-
angular lanceolate ; subdivisions of the stipe alternate, petiolate, divari-
cate ; pinnules mostly in pairs, (zygophyllous) trapeziform, sub-ovate,
obliquely cordate at base ; apex truncate, (about half ii. ch long by one
third or one fourth inch broad) veins immersed in the substance of the
pinnule ; veinlets once or twice forked near the lateral margin, where
they bear the sporangia, which form a marginal spore extending the
whole length of each pinnule on each side, more or less covered by the
reflected membranaceous margin of the pinnule; stipe yellowish brown,
smooth above, chaffy near the roots, sub-scandent ; about two feet high.
Grows among granite rocks in the mountains of the Camanche country,
Texas. (Oct. 1839.) Natural order Filices.

Pteris Buckleyi. Frond nearly glabrous, bipinnate ; outline lanceo-
late ; (two to four inches long by less than one inch in width) pinnce
alternate, subsessile, wedge-ovate in outline, partly pinnate, partly pin-
natifid; pinnules or lobes obtuse, sub-ovate, or oblong, or (by the ap-
proximation of the opposite sori) linear-oblong, sessile, decurrent ;
veins alternately and ramosely forked ; proper midrib none ; sporangia
arranged to form narrow continuous marginal sori, covered by the mem-
branaceous reflexed margin of the pinnule; stipe black,shining, wire-like,
one fourth of a line in thickness, glabrous, sub-pubescent where it is
continued through the frond, arising from a tuft of dense ferruginous
wool at the base, longer than the frond, apparently csespitose, four to

Z)r. Riddell on the Plants of the South West.

617

eight inches. Limestone cliffs on the Tennessee river, at Florence.
Alabama, where it was found by S. B. Buckley in 1848. Natural or-
der Filices.

Dryopteris Aureliana. Frond lance ovate in outline, tapering from
below the middle towards the base, sub-pilose, pinnate ; two or three
lower pairs of pinnules reflexed ; pinnules nearly opposite, sessile, ob-
long, linear, acute, deeply pinnatifid ; lobes oblong, rounded, minutely
repand, bearing sori always distinct near the margin ; venation simply
pinnate, veinlets simple and passing centrally beneath the sori ; stipe
chaffy below. One to two feet high. Damp woods, New Orleans, and
in other parts of Louisiana. June to August. Habitually more robust
and of a deeper green than D. Noveboracensis, which in other respects
it very closely resembles. Natural order Filices.

Dryopteris Rafinesquiana. Frond broad deltoid lanceolate, not tap-
ering below, rather attenuated towards the summit, pinnate ; pinnules
vaguely alternate, sessile, lance- linear, ensiform, pinnatifid ; divisions,
extending about two thirds of the way to the midrib ; lobes wedge-ovate,
obtusish ; sori round in rows on each side of the midrib of the lobe
equidistant from the midrib and the margin, seldom crowded, never con-
fluent ; indusium peltate, orbicular or kidney-shaped ; venation as in
D. Aureliana. Frond often more than one foot broad. Two to four
feet high. In fruit from April to November. About New Orleans and
elsewhere in Louisiana.

Closely related to D. Noveboracensis, but differs from it in its chaffy
stipe, different outline, and much greater size. Dedicated to the late
C. S. Rafinesque, who, after years of excentric devotion to American
botany, died 1840 in Philadelphia. Plants of La. No. 1784. Natural
order Filices*

Lastra3a petiolata. Frond long lanceolate in outline, broadest about
midway and tapering both ways, partly bipinnate ; pinnules petiolate ;
lower ones sub-cordate, triangular ovate, pinnatifid ; middle ones pin-
nate, lance-linear in outline; upper ones pinnatifid, linear, falcate; lobes
oblong and linear oblong, usually curved upwards, rounded at the end,
serrulate; fertiles one often sub- pinnatifid ; veins p innately forked ; sori
circular and twice as large as in Lastraea cristata, placed midway be-
tween the midrib and margin, becoming sometimes nearly confluent ;
indusium peltate, nearly orbicular ; stipe chaffy. Marshes Louisiana
and Florida. Three to five feet high. August. Closely related to
L* cristata. Plants of La. No. 1785. Natural order Filices.

Lycopodium corallinum. Leaves lance-ovate, subulate, carinate, less

618

The New-Orleans Medical and Surgical Journal,

than one line long, in eight indistinct rows, appressed and imbricate
upon the stem ; spikes numerous, terminal, arising continuously from
the branches, 4-sided, from a quarter to half inch long and near the
tenth of an inch thick, sub-erect ; bracts ovate, cuspidate, sub-membra-
naceous, larger and longer than the ordinary leaves ; sporangia hidden,
axillary, yellow, spheroidal bean-shaped, sub-compressed, near one
sixth of a line in diameter. Csespitose, not creeping, stems branching
and about half a line thick. Perennial and sempervirent on dry granu-
lar quartz rocks at Kaolin creek, near the San Saba, Texas. (Novem-
ber, 1839.) Also near Kisatchy Springs, Western Louisiana, where
it has been found by Dr. Hale. Plants of La. No. 1797. Natural or-
der Lycopodiacese.

IX. — CASE OF STRANGULATED FEMORAL HERNIA.

BY G. T. BROWNING, M. D., NEW ORLEANS.

On the morning of the 14th of December last I was requested to visit
Mrs. T., a poor Irish woman. Upon reaching her abode, I found thaV
she had been suffering severe pain for thirty-six hours, caused by a tu-
mor in the right groin, which upon examination, as well as from the
woman's own history, I was induced to believe was a femoral hernia.
The contents of the stomach were very frequently rejected. The taxis
was gently employed for some time without gaining any advantage ; not
having a warm bath at command, fomentations were ordered to the
abdomen, and a mixture containing Morp. Sulph. grs. iij, Sod. Bicarb.
3 i, Muc. G. Acacia § iv, of which one spoonful was to be taken every
hour until sleep was caused, or the vomiting restrained. Lumps of ice
to allay thirst.

At my next visit the tumor was the same, the pain and vomiting
somewhat less. The taxis again failed. Ordered ice over the tumor,
and the lower intestines to be emptied by enema. On the night of the
15th the symptoms remained about the same, with the addition of slight
peritonitis. An infusion of Tobacco was now directed to be thrown up
the rectum, but for lack of an attendant the instruction had not been
carried out.

On the morning of the 16th, the woman was willing to act upon the
advice which I had previously given her, and be conveyed to the Cha.
rity Hospital, that the operation might be performed, or the reduction
of the Hernia, under other hands, be accomplished. This, however,

Br, Browning on Strangulated Hernia.

619

was found impossible, after having been placed in an anaesthetic state
by chloroform, by any degree of force proper to be used on such occa-
sions.

Prof. Wedderburn, into whose ward the patient had been sent, was
anxious to operate immediately, and whilst still under the influence of
chloroform, it was decided to return the strangulated intestine by the
employment of the knife ; accordingly the Professor made an incision
over the body of the turnor, about an inch and a half in length, carefully
dividing the integument and superficial tissues, until the sac was reached,
which presented a very dark appearance. It was now found that the
opening was too small to allow the strangulated sac and intestine to
repass into the cavity of the abdomen ; it was therefore necessary for
the operator to pass his finger with a blunt pointed hernia knife down
to the ligament, and after making a slight incision, about the eighth of
an inch, the sac quickly passed in. The operation, it will be perceived,
was performed without opening the sac, a mode which, upon good au-
thority, is maintained to be superior to that which has been generally
employed.

The woman was now ordered 20 grains of quinine and 3 of opium,
and to be removed to bed. For several days the case progressed fa-
vorably, and on the tenth day after the operation it was the intention
of Mrs. T. to have left the Hospital ; three days prior to which, how-
ever, tetanus supervened, and on the twelfth or thirteenth day after en-
tcring the Hospital she died.

[Dr. A. R. Nye, Assistant Surgeon of the Charity Hospital, has kindly
furnished the following note of the post-mortem examination of this
case. — Ed.~\

POST-MORTEIH.

Externally the wound had perfectly healed ; indeed this was the case
with nearly the whole course of the canal through which the intestine
had passed. There was a very little matter just external to the Sep-
tum Crurale, which connected with the cavity of the abdomen through
a small opening (scarcely larger than a probe) in the Septum. The
sac formed by the peritoneum seemed to have suppurated away. The
portion of strangulated intestine had been about three feet from the
colon in the Ileum. The two portions of the intestine which had been
brought in contact at the seat of stricture, were bound together by
slight adhesions. The portion of intestine which had been strangu-
lated was gangrenous.

620 The New-Orleans Medical and Surgical Journal.

About three years ago this woman had suffered from Hernia, whilst
living in Philadelphia, and was about to undergo the operation, (the
hernia having existed for several days) when, being placed under the
influence of chloroform, it yielded to the taxis.

It is admitted that the chief danger to be apprehended in this opera-
tion, is from too long delay prior to having recourse to it, since aside
from the frequently fatal consequences attendant upon such delay, the
patients generally recover.

A modern writer upon the subject of Hernia observes, " My decided
impression is, that the reason why the operation is so frequently followed
by death, instead of being one of the most successful of the great ope-
rations of surgery, is, too great delay in resorting to an operation, and
the undue and injurious use of the taxis, even after its adoption has
proved unavailing."

To what then (unsatisfactory as the enquiry may he) shall we, in the
present case, attribute the fatal issue ? The hernia had existed about
four days before the operation was performed — a longer delay, doubt-
less, than would have been recommended under existing circumstances,
had the well being alone of the patient to be considered ; yet as the
operation exhibited no gangrene of the parts, and as the peritoneal in-
flammation quickly subsided after the operation, showed that the con-
tents of the intestines had not escaped into the cavity of the abdomen,
and as she had so far convalesced as to be preparing to leave the Hos-
pital, the final result cannot be attributed to delay before the opera-
tion.

Tetanus seems then to have been the proximate cause of death,
owing, perhaps, to over exertion too soon after the operation.

An abstract of the above case is reported by Dr. McGibbon, Record-
ing Secretary of the Physico-Medical Society, in the January number
of the Monthly Medical Register. At the time of mentioning the case
to the Society, it was progressing favorably. The subsequent change
has already been stated, and hence the propriety of the present report.

Note. — In Strangulated Hernia, if time (which is always precious in
such cases) permits, we should never feel satisfied with our therapeutic
means, until we have tried the effects of full doses of opium. Case
upon case have been effectually relieved, when the operation has been
decided upon, and the patient refused to submit to the knife, by this treat-
ment ; and it is always the duty of the Surgeon, when practicable, to
give the opium treatment a full and fair trial.

Dr. Browning on Strangulated Hernia.

621

With pounded ice to the tumor, and repeated large doses of opium,
preceded, if necessary, by a copious bleeding, we believe more than
half the cases of Strangulated Hernia met with in private practice,
might be returned or relieved without the use of the knife. We know
there are cases for which the knife is the only remedy — but they are
exceptional, and commonly serve to encourage us in the opium treat-
ment. The dose must be large — from three to six grains — and repeat
according to the urgency of the symptoms and the effects produced. — Ed.

|) art Sctcmb.

EXCERPT A.

I. — On the use of Purgatives in the treatment of Bilious Fevers, and other Bil-
ious Affections of the South and West.

BY SAMUEL G. ARMOR, M. D.

In withholding active purgation in the treatment of a class of diseases which
prevails during the hot summer and the fall months, especially in the Southern
and Western States, I am aware that I come in conflict with high authority ;
and I would not presume to question such authority, but for the conviction,
strongly impressed upon my mind, that as a class of remedies, they are dan-
gerous in the treatment of what are commonly called the Bilious, or Bilious
Remittent Fevers of the South and West. It appears to be a common impres-
sion with many, that purgatives are the only remedies necessary in the treat-
ment of this class of fevers.

It is not my purpose, at present, to inquire into the pathological relations of
morbid hepatic secretions, further than as connected with diseased action of
the gastro-intestinal mucous membrane. The general principles of pathology
and practice, however, apply to all derangements of the hepatic functions.

Although lesions of secretions are generally classified by writers on Pathol-
ogy as primary elements of disease, yet a close examination of the subject
must satisfy every reflecting mind that they are mere symptoms, or sustain
secondary relations in the order of pathological manifestations. Before the
lesion of secretion takes place, must there not be either a lesion of the blood,
of the circulation, of structure or of innervation? A clear conception of this
fact would, I think, throw light on a class of diseases associated with derange-
ment of the hepatic function, and banish from our Nosology those numerous
primary and idiopathic affections which are attributed to the liver.

It must be acknowledged, however, that as an excretory and depurating or-
gan, the liver performs an important function in the animal economy ; and the
rationale of its increased action, and consequently increased stimulation, dur-
ing the hot summer and fall months, must be apparent to every one who is fa-
miliar with the relation it sustains to the respiratory function. And the very
importance of its office is a sufficient reason to induce us to investigate more
closely its varied pathological conditions, that we may strike out, if possible,

Excerptd.

(528

the first link in the chain of morbid action, and thus annul a train of secondary
affections resulting from the forward action of a morbid secretion.

The peculiar tendency of Duodenitis to produce functional derangement of
the liver has long been recognized by observers. The distinguished physiol-
ogist, Broussais, was the first, I believe, to call attention to this subject, and
afthough he carried his views to great extremes, yet everlasting honor is due
his memory for the clearness of his expositions of diseases of the gastrointes-
tinal mucous membrane. It is true, that so far as relates to the duodenal
mucous membrane, different explanations have been given of the jaundice that
so frequently follows. It has been supposed that a swollen condition of the
mucous membrane extending into the ductus communis choledochus, gives rise
to mechanical obstruction to the flow of bile from the gall duct; and although
in many instances this explanation may be the true one, yet the fact that we
may have jaundice without closure of the common duct, is adverse to the unil
versality of this explanation. We are led to infer, therefore, that the elements
of the coloring matter of bile exist in the blood in health, and that other causes
may impair or entirely suspend the secretory function of the liver ; thus per-
mitting the coloring matter to accumulate in the blood. In cases of this kind,
with the usual manifestations of an icterode appearance of the eyes and skin,
and white or clay colored fecal evacuations, we do not often have very marked
tenderness over the region of the duodenum.

The question may arise, then — what is the morbid agency which gives rise
to increased, suspended, or perverted action of the liver? The answer to this
would show that the causes are various, although all agreeing, perhaps, in
many essential particulars.

First, congestion from intropulsion of blood, whether from the cold stage of
an intermittent fever, or from protracted cold to the surface, will give rise to it.
The result of the congestion from any cause, whether active or passive, is the
lowering of the vital properties of the gland, and a consequent suspension or
perversion of secretion.

Again, perverted secretion may result from a primary diseased condition of
the blood itself.

Or lastly, we may adopt the explanation of Bichat, " that between a secret-
ing organ and the surface upon which its excreting duct opens, there is a sym-
pathy by which a stimulus applied to the latter is communicated to the for-
mer." As applied to the liver, I should have enumerated this as first in the
order of causes, because most important. The illustration of this law is very
manifest. We have a familiar one in the effects of food, tobacco, or other stim-
ulating substances taken into the mouth. A copious secretion from the sali-
vary glands is the result. We have no explanation of this but that based on
the influence of the sympathetic system of nerves over organic functions, and
as applied to secretory organs, we have abundant evidence of this influence.
Mental emotions also, such as anger, anxiety, fear and terror, very sensibly
affect the secretion of glands. And so great is this perverted nervous influ-
ence, that it frequently affects, in a very marked degree, the quality as well as
quantity of the secretion. Instances are on record, apparently well authenti-
cated, of the secretion of the liver being rendered so acrid by violent emotions
of anger, that at the moment of ejection it irritated the mouth, fauces and
orifice of the anus. And the instance related in Carpenter's Physiology, of
the violent combat between the soldier and the carpenter, whose wife was nur-
sing a young infant, very forcibly illustrates the effect of passion in changing
the secretion of the mammary gland. In our pathological reasonings we do
not, perhaps, duly appreciate the influence which the great sympathetic system
of nerves exercises over secreting structures.

These remarks are introduced for the purpose of showing that disordered
hepatic secretion is a secondary condition, to he removed only by removing

824

The New -Orleans Medical and Surgical Journal.

the cause. Hence, in a practical point of view, the very important inquiry as
to the nature of the cause.

But if from any cause, general or local, inflammatory or irritative, there is
an interruption of the accustomed actions of a secreting organ, congestion of
its vessels follows. As applied to the liver, diminished secretion of bile gives
rise to a congestive state of the vena portarum and its branches, and in some
cases, to a similar state in those organs whose venous system is associated
with that of the liver.

This organ, like all others, may be the seat of congestion, of iflammation,
or of both. In speaking of congestion of the liver, I allude to a condition es-
sentially different from inflammation of that organ. In acute inflammation, it
is mainly the arterial action of that organ that is excited, and the congestion
is arterial ; whilst in venous congestion of the liver, consequent upon an inter-
ruption in its secretory action, the arterial system of the liver is necessarily but
little, if at all affected ; the congestive state of that organ being, in all proba-
bility, limited to the vena portarum and its branches. But from the peculiar
vascular structure of the liver, while arterial determination must necessarily
be followed by venous congestion, it can in no instance, as in other structures,
contribute towards the relief of that condition.

If my premises then be correct, why do we administer cathartics for the relief
of biliary derangement? I am aware that it is argued, theoretically, that the
serous exhalation from the intestinal canal, caused by the action of a cathartic,
unloads the vessels of the liver, and thereby restores its healthy circulation ;
and this argument might have weight, were it not for the counteracting influ-
ence of irritation, caused by the operation of the remedy ; but this element of
evil, I doubt not, more than overbalances all the benefit derived from the deple-
tion. In many instances, the manifestations of biliary derangement are produ-
ced by irritation and phlegmasia of the mucous membrane ; and it is very evi-
dent that this condition would be only exasperated by purgatives. An increased
irritation is communicated to the parenchyma of the liver, and whateverjbe the
intensity of the phenomena attributed to the bile, calmness is generally re-
established as soon as there is a cessation of the local phlegmasia. I regard
this as an established fact in pathology of the highest importance-

In our ordinary bilious fevers, therefore, accompanied as they generally are
with irritation of the stomach and bowels, I would abstain from the use of
cathartics as calculated to aggravate the symptoms of biliary derangement
and increase all the phenomena of the disease. I would not be understood,
however, as entirely excluding alvine evacuants in the treatmeut of these fe-
vers. Their operation is sometimes doubtless attended with benefit. The acrid
secretion may be a greater source of irritation, forward upon the mucous mem-
brane, and backward upon the gland secreting it, than would be the effect of a
laxative to remove it ; but it would be with this view, mainly, that I would ad-
minister them. The other fact, namely, that the tendency of cathartics is to
increase the phlogosis of the mucous membrane, and that this condition is,
through sympathy and direct continuity of structure, communicated to the
liver, should ever be borne in mind.

If their effect be to indirectly at least stimulate the liver, our deduction may
be regarded as illogical. The question may be asked, is not this the great
object to be effected ? Grant that it is, to say the least of it, a desirable object,
and still it by no means follows that the enteric and hepatic excitement will
be promotive of biliary secretion. Is not indeed the converse of it true 1 Yet
there may be a possibility that the secretory action of the liver is suspended
from the want of the normal sensibility of the duodenal mucous surface.

The chyle, which is the natural stimulus of this surface, may as a conse-
quence, fail to communicate its stimulatory impression to the liver, and a so?t

Kxcerpla.

625

of torpor or paralysis may be the result. This condition is generally mani-
fested by the clay colored or white discharges from the bowels, unaccompanied
by hyperaemia and tenderness. If we are able to diagnose this condition, then
purgatives, especially the mercurial ones, maybe admissible ; although even in
this case, broken doses of calomel, short of purgation, would be better prac-
tice.

Is it true, that in the class of cases under consideration these are the man-
ifestations ? Is not indeed the very opposite condition generally present, such
as local tenderness, irritability of the stomach, and dark discharges, indicating
morbid sensibility and hypersemia of the mucous membrane to the point of
effusion of the morbid and fluid elements of the blood ?

Shall we then in this condition administer cathartics ? Many reasons for-
bid ; I will be content with enumerating a few :

1st. As a general and valuable therapeutical principle we should never resort
to medicinal agents when nature is doing her proper work.

2d. Cathartics will, in all probability, increase the very difficulty which na-
ture is endeavoring to overcome, by adding irritation and determination to the
congestion already existing.

3d. Protracted congestion of the liver, by damming back the venous circula-
tion of the abdomen, may give rise to formidable disease of the intestinal mu-
cous membrane.

And lastly, there is no indication, as a general proposition, for their use, as
evinced by the color and character of the discharges from the bowels ; tne
dark discharges characterizi ng hyperaemia and effusion, positively contra-indi-
cating their use.

I might add, that experience abundantly demonstrates not only the inutility,
but the positive injury following the use of active and repeated purgation in
the treatment of the miasmatic fevers of the Mississippi Valley. I doubt not
but that hundreds have fallen victims to erroneous views on this subject, pro-
pagated by Hamilton in his work on Purgatives.

I have alluded more especially to the use of cathartics in the treatment of
ordinary bilious fevers, as they are generally termed, and have called attention
to but one pathological feature of the disease. In so doing, I would not be
understood as referring all the phenomena of bilious fever to derangement of
the biliary organs ; nor to enteritis or gastro-enteritis as the cause; not-
withstanding this is undoubtedly a frequent and formidable super-addition to
the general fever.

The effect of cathartics is also bad on the gastric mucous membrane, and
consequently on the functions of the stomach ; and it is only necessary to re-
flect on the importance of the perfect action of the digestive apparatus to a
maintenance of a healthy condition of the entire system, to be convinced of the
multiplied variety of secondary disturbances which may result from derange-
ment of the primary action of the series of animal functions. It is indeed the
" golden bowl at the fountain," the " wheel at the cistern," and if its functions
be perverted, disturbance is, of a physical necessity, propagated remotely through
the system. Strike upon the first link of the chain of sympathies, and vibra-
tion runs through its whole extension. Hence the varied course which the
derangement of function may pursue^ and hence the„ difference of character
which disease may ultimately assume. If this thought were more rigorously
pursued in all our investigations at the bedside, the result would doubtless be
a more rational and simple practice.

Medicine has too often and long been engaged, and too often worsted, in the

826

The New-Orleans Medical and Surgical Journal.

contest with affections of an idiopathic and independent character, which
were the secondary, or perhaps more remote result of pathological derange-
ment; and in no instance, perhaps, have we a more striking illustration of
this than in diseases of the gastro-intestinal mucous membrane.

[Ohio}Medical and Surgical Journal.)

II.— Statistics of Cancer.

Sir — Your Journal of the 22d of May contains a statement, quoted from the
first of the lectures which I recently delivered at the Royal College of Sur-
geons, to the effect that " persons operated upon for cancer die, upon an aver-
age, thirteen months sooner" than those upon whom no operation is per-
formed.

Allow me to observe, that the statement had reference to cases of schirrous
cancer of the breast. In such cases, I believe that the general average dura-
tion of life, after the patient's first observation of the disease, is 49 months ;
that the average life of those whose breasts are removed, and who survive the
effects of the operation, is forty-three months, and that the average life of
those in whom the disease is allowed to run its course, is about fifty-five
months.

In the second lecture, I said that the general result of operations for medul-
lary cancers is very different ; and that although they are so seldom long sur-
vived that they are generally considered to be less beneficial than the opera-
tions for schirrous cancers of the breast, yet, on the whole, they are more so.
The general average of life of persons affected with medullary cancer of the
eye, testicle, breast, bones, or other external organs, may be reckoned at about
twenty-four months from their first notice of the disease ; but I believe the aver-
age for those from whom the primary disease is removed, and who do not die
in consequence of the operation, is about thirty-four months ; while the average
for those in whom the disease is allowed to run its course is scarcely more than
a year.

In the third lecture, I expressed the belief that on the whole the operation
for epithelial cancers is even more effective in prolonging life than the opera-
tion for medullary cancers; but that the wide diversities in the duration of life
amongst those affected with this form of cancer, make it very difficult at pre-
sent, to deduce such an average as may be relied on. And I would repeat what
I said in one lecture respecting all these averages, namely, that such general
results deserve only general consideration in the treatment of particular cases
of cancer. They may justly determine a general rule of action, but it can be
only such a rule as must admit of numerous exceptions. In many cases of
schirrous cancer there are sufficient reasons for operating ; and in many cases
of medullary and epithelial cancers, reasons as sufficient for refraining. The
right course must in each case be determined by a just appreciation of all the
conditions each presents.

I am, sir, your obedient servant,

JAMES PAGET, Henrietta st, Cavendish Square-
June, 1852. [Ibid.

Excerpta.

627

Society for the Relief of Widows and Orphans of Medical Men,

The anniversary dinner of this Society took place at the Astor House, on
the 10th ult., as announced in our last. The attendance was large, and every
thing passed off in the most satisfactory manner. After the invocation of a
blessing by the Rev. Dr. Vermilye, ample justice was done to a sumptuous
entertainment, got up in Coleman and Stetson's best style.

Letters were read from Gov. Fish, Hon. Francis Granger, and Hon. H. T.
Duncan of Kentucky, the latter enclosing a handsome donation.

Dr. Delafield responded to the first regular toast, " Our Society," etc. The
next toast, ;' The iiberal professions, they meet the three prime necessities of
humanity, happiness, secured by religion ; liberty, by law ; and health, by sci-
ence," was happily responded to by the Rev. Dr. Vermilye on the part of the
clergy, by J. W. Gerard, Esq., on the part of the law, and Dr. Stevens on the
part of the Medical profession. A speech highly complimentary to the medical
profession was made by Mayor Kingsland.

The " Army and Navy," etc., was responded to by Dr. Decamp in behalf of
the army, and Dr. Guillou in behalf of the navy.

Dr. Francis, in answer to a loud and unanimous call, responded to the fourth
and last regular toast, " Woman, without her Eden lacked its chief blessing ;
with her the humblest cottage becomes an Eden," and delighted the Society
with one of his characteristic speeches, overflowing with humor as well as
good feeling Speeches were also made by Drs. Henschel, Detmoldand Gris-
com, the former as President of the German Medical Society.

Dr. William Cockroft of this city, and Dr. Mercer of New Orleans, consti-
tuted themselves Benefactors of the Society by the payment of $150 pach.
Donations were received from Hon. H. T. Duncan, of Kentucky, Mayor
Kingsland, Mr. Charles Stetson of the Astor House. Gen- Macdonald of Flush-
ing, Mr. Quintard, Dr. Jacob Harsen, Prof. A. Clark, Doctors Dubois, Bor-
rowe, etc., amounting in the whole to nearly two hundred dollars. Several ap-
plications for membership of the society were presented.

The annual statement of the Secretary of the Society, copies of which were
freely distributed, states the present number of members to be eighty-one, of
whom thirty-one are life members by the payment of $i00 at one time. Two
have joined the Society during the present year, and twelve members have died
since the organization of the Society.

The amount of the funds of the Society is Si 2,542 49

Invested in bonds and mortgages at 7 per cent, $12,300 00
Deposited in Favmer's Loan and Trust Company, 242 49

$12,542 49

The following gentlemen have constituted themselves Benefactors of the
Society bv the payment at one time of one hundred and fifty dollars each,
namely, Edward Delafield, M, D., A. Gescheidt, M. D., William Detmold,
M. D., Thomas Ward, M. D., and A.H. Ward, Esq., being the first lay bene-
factor.

One family, that of a late member recently deceased, is enjoying the benefit
of relief from the Society, the first recipients of its aid since its foundation,
which now dates ten years back; the widow receiving $100, and each of
five children, under fourteen years of age, $25 annually, in semi-annual
payments.

628

The New-Orleans Medical and Surgical Journal.

The annual meeting of the Society was held on the 24th ult., and the fol-
owing are the present members of the Society :

James C. Bliss, M. D.5 President.

James Anderson, M. D., }

A. H. Stevens, M. D., > Vice Presidents.

Valentine Mott, M. D., )

Isaac Wood, M. D., Treasurer.

H. O. Bulkley, M. D., Secretary.

(N. Y. Medical Times.)

IV. — Professional Aphorisms.

The talented editor of L'Union Medicale, M. Latour, lately gave a few ex-
tremely apposite and amusing professional aphorisms, in one of his clever feu-
illetons. We shall extract a few.

1. Life is short, the making of a practice difficult, and professional brother-
hood deceptive.

2. A man's practice may be compared to a field, on which tact acts as a
manure.

3. A medical practice may be likened to a flannel waistcoast ; neither can
be left one moment without risk.

4. The practitioner who is often absent runs the same danger as a lover, for
both may find themselves supplanted on their return.

5. Take great care of your first patients, ye beginners! for these are the
seed from which your practice is to spring.

6. When a medical man wishes to get rid of a troublesome patient, he need
but send in his bill.

7. The practioner who expects his reward from the gratitude of his patients,
may be likened to the countryman who waited, in order to cross the river, until
the waters had done flowing.

8. To ask an exorbitant fee always redounds to the disgrace of the profession.
A wealthy patient, who was asked an enormous sum by a surgeon, after an
operation, answered "You ought to have said at first, ' Your money or your
life.' "

9. When the blind credulity of the public in medical matters is considered,
one does not wonder thatthere are so many quacks and imposters, but, on the
contrary, that there are still so many upright medical men.

10. Consultations are either very useful or dangerous, just as the usual me-
dical attendant knows how to manage. It is foolish to have recourse to them
too often, but still more foolish to reject them altogether. Don't wait until the
friends of the patient ask for a consultation; but don't talk of consultation if
you think the issue will be favorable.

11. It is not an easy task to come out of a consultation without being a little
lowered in the estimation of the patient or his friends; the more so, as there are
physicians and surgeons, who, with the utmost urbanity, throw out perfideously
concealed hints, which the practitioner should immediately take up, and boldly
insist upon a clear statement.

12. A consultation is very often a sort of note of hand, drawn by the usual
attendant upon the patient, for the benefit of the physician called in to give
his opinion.

At the conclusion of these excellent and well told aphorisms, (of which we
have extracted but a very few) M. Latour very justly finds fault with the exag-

Excerpta.

629

gerated delicacy of the Medical Societies of Paris, who reject all those practi-
tioners who put a plate to their doors.

The author likewise discusses the habit of giving instantaneous fees to phy-
sicians and surgeons, which prevails in England, and advises his fellow practi-
tioners not to insist upon this mode of payment. He shows that the bulk of
the profession are paid, both in this country and in France, in the same man-
ner—namely, at the expiration of a determined period, or at the end of the
treatment. (London Lancet.)

V. — The Medical Treatment of the late Duke of Wellington.

Every event connected with either the life or death of the renowned hero
and distinguished statesman, whose loss England now deplores, has become of
more or less historical importance. Strange then is it that the exact period of
the birth of the great Duke of Wellington should be still a matter of uncer-
tainty, and that the immediate cause of his death should be a subject of doubt
and "discussion. As it is probable that the Lancet will be referred to by histo-
rians for correct information on the professional points that may become the
subjects of their inquiries, the following narrative of the principal events
connected with the recent calamity may be relied upon as perfectly au-
thentic.

The Duke of Wellington was supposed to be in his usual health until the
morning of the day of his death ; how far this opinion may be correct will sub-
sequently appear. He had been engaged until dusk ot the preceding evening
in reading the Report of the Oxford University Commission, and did not sus-
pend his labors until compelled by inability to distinguish the print ; having at
the time noticed the light on the opposite coast, he observed that it was the
4i darkness," and not the failure of his sight, which caused the print to "bother"
him. He dined heartily shortly afterwards, at seven o'clock, and took for din-
ner mock turtle soup, turbot, venison and pudding. As was his usual practice,
he drank neither wine nor spirit. He retired to bed before ten o'clock, and
during the night visited the closet. The appearances found there showed, that
whilst the functions of the bowels were healthily performed, the Duke, con-
trary to his habit, must have returned hastily to bed, probably in pain. His
Grace's valet, Mr. Kendal, who called him at his usual hour, shortly after six
o'clock, observed that his master was not well, and that his breathing seemed
oppressed.

His Grace not appearing disposed to get up, his attendant, after remaining
some time in the room, left him until half past seven o'clock. Returning at
this time, he was directed be the Duke to send for the apothecary. This he
(Mr. Kendal) immediately did, and Mr. Hulke, of Deal, was in attendance
about nine. He found his Grace complaining much of pain across the chest,
and at the pit of the stomach. His tongue was furred ; he had distressing
eructations, and his pulse was irregular. It was intimated by Mr. Hulke that
he would send a draught, and he recommended that his Grace, in the mean-
time, should take a little warm tea and toast. Mr. Kendal shortly afterwards
endeavored to act on this recommendation, but the Duke seemed unable to
swallow the tea. He became sick, and threw up a portion ot the venison he
had eaten the evening before. This piece of meat had not been altered in ap-
pearance by the process of digestion. A general convulsive attack ensued, of
some minutes' duration. After the fit, the Duke to some extent recovered his
consciousness. He laid on his back, his favorite position when in bed, with
his hands clasped, and placed at the back of his head, his eyes occasionally

630 The Neiv-Orleans Medical and Surgical Joufnah

following persons in the room. Mr. Hulke was immediately sent for again
and speedily returned, accompanied by Dr. McArthur. His Grace had another,
but less severe convulsive attack, between eleven and twelve o'clock. Further
medical assistance was sought for from London, and telegraphic messages
were sent to Dr. Hume, who had long been the medical attendant of the Duke,
to Dr. Robert Ferguson, a friend of Dr. Hume, and to Dr. Williams, who alone
of the three happened to be in town, but who, unfortunately, did not arrive till
the Duke had for several hours ceased to live. This lamentable event oc>
curred about half past three.

After the first convulsive attack, the Duke's exhaustion rapidly increased,
and his breathing became much embarrassed ; he had slight tvvitchings in one
arm, but no paralysis. When an effort was made to give him either medicine
or drink, his Grace generally exhibited reluctance to take it, pushed away
whatever was offered to him, and showed his usual dislike to be interfered with.
The treatment employed consisted of a mustard poultice applied to the pit of
the stomach by the valet ; a mustard emetic, partially administered, and with*
out action ; a dose of calomel and small quantities of stimulants were offered
to the patient, but were not swallowed. For some time before his death, his
Grace had been removed to a chair, to relieve the difficulty of breathing ; but
his medical attendants, finding that his pulse, already extremely feeble, became
in that position still weaker, his Grace was again restored to the recumbent
posture.

Such, then, appears to have been the progress of the short and fatal illness
of the great Duke of Wellington — an illness that terminated so calmly, that
not an expiring movement was observable by the medical attendants pre-
sent.

Let us seek, from this history, to discover the cause of the terrible calamity
the nation so deeply laments.

It must in the first place be remembered, that the atmosphere of the sea
coast, when at all cold, causes in the aged, or in debilitated persons, more or
less accumulation of blood in the internal organs, and more or less consequent
impairment and irregularity of their functions. During some days preceding
the 15th of September, the day of the Duke's death, there had been a hot mid-
day sun, a considerable wind, chiefly from the north, and the evenings and
nights were cold and chilly. The thermometer on the night preceding the fatal
event, was only six degrees above the freezing point ; on the preceding day it
had been up to 92 degrees. No precautions were taken to obviate the effects
of such a change on the aged and necessarily weak system of the Duke, and
the palor of his countenance, observed on the preceding Sunday, showed that
this influence was telling on the circulation. The stomach was thus ill pre-
pared to receive a hearty dinner, and the difficulties of that organ were further
increased by receiving a considerable quantity of food imperfectly masticated,
in consequence of the Duke's loss of teeth. Nor was the process of digestion
promoted, or the powers of the stomach and heart invigorated, by the use of
stimuli. The stomach therefore contained a mass of undigested food, and be-
came distended with flatus : the functions of the lungs were impeded ; the
heart's action was disturbed ; the nervous system participated in the morbid
processes going on ; and as a child would have convulsions under similar cir-
cumstances, so had the Duke of Wellington, who, becoming exhausted by the
disturbed and enfeebled condition of his nervous and circulating systems, rap-
idly sunk and expired. Why or wherefore such an attack should be called epi-
lepsy, we are at a loss to conceive. The certificate of death, at least as it has
appeared in the journals, is not correctly expressed.

The subject of the treatment afforded to the Duke has been fully discussed;
but it is hardly fair for those who were not present, and therefore ignorant of
the difficulties met with, to condemn it. We shall not refer to what was done,

Excerpta,

631

or what was left undone, but briefly state what, under the circumstances as
represented, might have been done, with the prospect of a gratifying re-
sult.

We have already alluded to the risks which the changes of temperature,
more especially on the coast, entail on the feeble and the aged ; wTe need not
say how they may be watched, and their effects obviated. There is no ques-
tion that these influences were exerted over the Duke of Wellington, a man in
his 84th year, who was habitually careless as to external impressions, and who
studiously avoided wine and spirit. Aged persons, whose digestive powers ne-
cessarily participate in the subdued energies of the constitution, ought to be
careful as to the quantity and quality of the food they customarily consume.
Great neglect on these points must be attended with annoying, if not dangerous
consequences. Nor should it be forgotten that weak stomachs, after a hearty
meal, are greatly assisted in their functions by the moderate use of stim-
ulants.

It is probable that had the Duke's stomach been relieved by vomiting in the
early part of the morning, he would now be with us ; it is even possible that
such an effort, if successful at nine o'clock, might have saved him ; but every
hour added to the exhaustion, and rendered such an act more difficult. Under
such circumstances, that is to say, when stimulants cannot be administered by
the mouth, stimulating and nutritive lavements should be administered; and
these may be rendered anti-spasmodic in cases where convulsions exist. Sup-
port in such cases is essential, for though the stomach is occupied by the mass
of food, none is digested, none enters the system, which literally sinks from
exhaustion and the irritation and disturbance of the nervous system, caused by
undigested food in the stomach, itself a mechanical obstacle to the free action
of the lungs and heart. An effort should be made to support the circulation,
which during the night more or less languishes, as the respiration becomes
slower during sleep, and to determine the blood to the surface by general and
continued frictions, and by mustard footbaths, the body being kept in that po-
sition which will cause the least possible exhaustion of the powers of
life.

The principles which directed and governed the great Duke of Wellington
will not be without their influence on individuals in every sphere and class,
who read attentively the details of that eventful life which has given volumes
to history, the most remarkable either ancient or modern. Neither will the
closing events of that life be without its advantages in conveying an instruc-
tive moral.

The strongest constitution cannot be roughly handled with impunity — ad-
vancing age must bear with it the impression that it does not possess the pow-
ers of youth ; and those who have to administer to sickness and suffering
must remember that all in this respect are equal ; and that rank, dignity and
grandeur should not produce a degree of timidity in the medical practitioner
that would allow a duke to die undisturbed, while the life of a plebian would
be saved, by an apparently harsh, but prompt and decisive action.

(Ibid.)

632 The New-Orleans Medical and Surgical Journal,

VI.— Under what circumstances does Hypertrophy occur — What are its causes
— and how is it effected in the various structures of the body 1
Simon defines hypertrophy to be a multiplication, or a magnification of the
normal elements — the exaggeration of a tissue, or of an organ, in its own
particular type. (Ed.) He says :

For instance, take a large liver ; I repeat, that you would not call it hyper-
trophied for being full of blood, or for having a quantity of serum or lymph
effused through its substance, or for being stretched and bulged by an abscess
or hydated cyst in its interior; but simply and singly you call it a hypertro-
phied liver, when it has got more liver than it ought to have— more of that
very stuff for which you call it liver, rather than muscle or skin.

It may, I think, be stated as a general fact in the economy, that if the nu-
tritive conditions be perfect, if the blood and the organs be what they should
be, whenever the active structures of the body renew themselves, they do that
and something more. Nature gives them enough for their exact necessity,
and for something beyond it ; they renew themselves more largely and luxuri-
antly than in their original construction.

Of this general fact or law lean give no casual explanation ; I cannot
say what makes it be so ; but its purpose is obvious, and it brings before one
vividly that vis medicatrix naturae, which the older physiology delighted to
speak of, watchfully strengthening every part of the organism in proportion
to the stress upon it, and always contriving that no active portion of the
system shall become languid, for the want of a sufficient renovating ma-
terial.

But, whatever may be the explanation of the fact, it seems to me the ex-
pression of a law including all the chief cases of pure hypertrophy. In all
such cases, if you look carefully into their whole pathological history, you see
what may be generalized as a vigorous reaction against waste ; a reaction,
which in every case, as I have said, seems to go somewhat above the exact
quantity of repair and restitution due to the part, and which, when it extends
over sufficiently long periods of time, is able to accumulate its effects as a
permanent overgrowth of the affected tissue.

The chief heads under which you may consider the subject of hypertrophy,
are the following : Hypertrophy of muscle; hypertrophy of glands; reparative
hypertrophy.

lc Muscle grows exactly in proportion to its exercise ; and this is true not
only of the voluntary muscles, such especially as those of the limbs, but even
still more remarkably, of the involuntary muscles. See, for instance, in 1 le
heart ; where any obstacle has opposed itself to the circulation of blood —
where the mitral orifice has allowed regurgitation — where the aorta has be' n
rendered rigid by calcareous deposit, or where its origin has been obstructed
by fibrinous concretions — how immensely the muscular substance of the veil
tricle increases in its thickness and its power. Or observe the bladder, where
enlargement of the prostate gland, or the presence of a calculus, or the perma-
nent impediment of a strictured urethra, has interfered during many years
with the process of urination, and you will find that the increased labor thus
thrown on the muscular coat of that hollow viscus will have caused it to be-
come hypertrophied to several times its normal thickness.

2. The hypertrophy of secreting glands has been very much overlooked, for
what is now an obvious reason. A gland may be materially hypertrophied
without being larger than its normal size ; it may merely be denser than natu-

Excerpta*

633

ral. The essential phenomena of the disease are only to be followed by the
microscope ; but they deserve the most attentive study ; for it is particularly
in respect of glands and secreting surfaces, that I would beg you to remem-
ber what I have already mentioned, that under certain circumstances, their
hypertrophy runs to inflammation, and produces destructive consequences.
Thus, in that more common form of Bright's disease which I have described,
in the Medico-Chirurgical Transactions, under the name of subacute nephritis,
there is an initiatory stage, in which it is difficult to pronounce whether the
organ be in a state of hypertrophy or inflammation ; that is to say, there are
none but normal elements present ; nothing but a profusion of the natural cell-
growth; and if it were not for the previous presence of albumen in the urine,
or perhaps for finding a few of the Malpighian bodies injured by the hyper-
emia, one might almost speak of the disorder as a mere hypertrophy in the
secretive structure of the gland. The same is the case, too, in respect of the
early stage of cirrhosis of the liver. It may be observed, that the causes
which produce this redundant cell growth in the glands, and which eventu-
ally excite inflammation in them, are precisely what are called their specific
stimulants, i. e., such ingesta, or such products of digestion, as excite them to
secretion. As the waste of a muscle is in contracting, so the waste of a
gland is in secreting; and thus, according to the universal law, excitement of
the secretory functions leads to hypertrophy of the secreting structure. Among
materials which excite the glands to their characteristic manifestations, and
which may be called stimulants of the glands, none are more energetic than
those very substances which the gland ought to eliminate. Nothing can more
thoroughly dispose a gland to action, and therefore nothing can more predis-
pose it to ultimate hypertrophy, than an increased accumulation in the blood
of those particular materials which the gland should appropriate to itself for
secretion. Hence no doubt it is, that when one of two symmetrical glands has
been removed, its fellow undergoes a slow hypertrophy, so as to do compensa-
tive work ; for the stimulant material in the blood, which originally divided
itself between two outlets, now concentrates itself on one, increasing first of
all its waste, and subsequently its nutrition.

The thyroid gland, in the disease called goitre, or bronchocele, often (if not
always) presents at its commencement a pure hypertrophy in the secreting
structure. You are probably aware that the natural arrangement of this organ
is in closed vesicles, lined, not by nucleated cells, but by simple nuclei, partly
applied to the walls of the vesicles, partly floating in their liquid contents.
Mow, when hypertrophy begins here, these nuclei undergo a higher develop-
ment, and give origin to large transparent cells, which fill and distend the lim-
itary membrane of the vesicles. Analogy would justify the suspicion, that
whatever exterior influences produce this endemic disease, must stand in some
peculiar relation of chemical affinity to the natural intra-vesicular secretion
of the gland, and that thus (principally, if not only,) they would possess
their power of stimulating the organ to increased efforts of secretion and
growth.

3. As respects the reparative process, I may give you one or two illustrations
of the general doctrine of hypertrophy ; as, for instance, this ; that in the me-
chanical structure of the body, where disease or accident has either weakened
a tissue, or has thrown augmented stress upon it, its reparation generally be-
comes hypertrophic.

We very commonly see this illustrated in the skeleton. If the tibia or fib-
ula be partially removed by disease, or by experiment, that one of the two
bones which is left is apt to undergo a kind of compensative development,
becoming thicker and stronger at the weakened portion of the limb. So, where
recovery has taken place from rachitic curvature of the spine, we find bone
deposited in various degrees of superabundance; sometimes locking the spi-
nous processes together, sometimes expanding the surfaces of contact of the

634 The New-Orleans Medical and Surgical Journal.

bodies of the vertebra, or anchylosing their edges. Or, in the bones of the
extremities, which have been bent by rickets in childhood, and have subse-
quently been repaired, we see strong ridges thrown up along the concave
aspects of the curve ; and this superabundant bone is placed (as Mr. Stanley
observed) exactly where the curvatures of the bones render them mechan-
ically greatly weaker, and where, as a consequence, their greatest waste of
tissue occurs.

The various osseous processes for muscular insertion, and the several sur-
faces of bony contact in the vertical plane of the trunk, are the portions of the
skeleton most liable to undergo excessive waste ; the former by traction, and
the latter by pressure, and they are the portions, consequently, most liable to
quantitative errors of nutrition.

Before leaving the subject of hypertrophy, perhaps I should mention another
law, though it is one of very limited application, viz., that with some contigu-
ous organs, mutual pressure is in so far a condition of harmonious develop-
ment, that the absence of one of such organs occasions some capricious growth
in the other. There appears to be this necessity of mutual pressure between
the brain and the bony case which contains it; and in patients where the
brain has undergone a slow atrophy from disease, the skull has been found pre-
senting a very peculiar hypertrophy, inwards, chiefly by the expansion of its
diplce, so that the inner table of the cranial bones has maintained its natural
contact with, and adaptation to, the shrunken convolutions of the brain. This
is perhaps not very frequent ; but in the majority of cases, where chronic
shrinking of the brain has occurred, the parts show the same tendency to the
maintenance of mutual pressure, by the effusion of a quantity of serum which
occupies all the interval between their separated surfaces.

Similarly with the alveoli, it can hardly be considered otherwise than in some
respects a hypertrophic process, that, the alveolus, from which a tooth has been
dislodged, fills itself with bone. . The teeth themselves too, under certain cir-
cumstances, sometimes show what is rather a simulation of hypertrophy than
its reality, as you may at any time see, by removing an incisor tooth from the
jaw of a rabbit. You will find that the opposite tooth, against which the re-
moved one used to press, grows to an unusual, almost to an indefinite length,
for want of the pressure and friction which formerly kept the waste of its free
edge in proportion to the growth of its other extremity. Obviously, the hyper-
trophy is here only apparent ; there is no true overgrowth of structure.

VII. — Poisoning Fungi.

A letter from Montierender, in France, says, that a woman who acted as
cook to M. de Coucy, a retired officer, brother-in-law to Gen. Oudinot, having
lately prepared some mushrooms gathered in a neighboring wood, served up
the dish to her master, and partook of it herself, as well as gave a portion of it
to another woman and her son, a boy of fourteen years. In some hours after
symptoms of poisoning appeared, and although every assistance was given,
the three adult persons expired the next day — the boy alone being rescued
from death.

Excerpia.

635

VIII. — Chloroform in Obstruction of the Bowels from Spasms.

BY J. D. CAIN, M. D.

Every physician meets, in the course of his practice, with cases of obstruc-
tion of the intestines, which has come gradually or suddenly, generally from
some cause of irritation existing in them. The obstruction in these cases
consists of a spasmodic contraction of a portion, or of portions of the intestines,
generally the small. The plan I formerly pursued was, to cease all attempts
at forcing a passage by means of cathartics, if one or two brisk cathartics
failed, and to resort to opium freely, enemata of warm water, melted lard or
butter, sweet oil, etc., the warm bath, fomentations to the abdomen, and other
means of inducing relaxation. For more than two years I have used Chloro-
form as a more powerful agent than opium, and its preparations, and as more
certain in relaxing the muscular system. The Chloroform, administered in
greater or less inhalation, soon produces a greater or less degree of resolution,
and taking advantage of the relaxation thus effected, I give enemata, either
stimulating, mucilaginous, or oily, which in a short time bring away faecal
matter. The inhalation may be repeated as often as in the judgment of the
physician the case demands.

Chloroform possesses the immense advantage over opium, of relieving effec-
tually and promptly the pain, and in not leaving the bowels in a constricted
state, the sedative effect soon passing off.

•Seven cases have been thus treated by me with highly satisfactory results.
In one case only have I experienced any difficulty in inducing the requisite
degree of relaxation of the bowels. The subject of this case was very slightly
susceptible to its influence ; but the pain was completely relieved by frequent
inhalations, and the obstruction gradually overcome.

[Charleston MedicalJournal.]

IX. — Homoeopathic Revelry.

The friends and supporters of the London Homoeopathic Hospital held their
anniversary festival lately at the Albion. A dinner is a sensible thing, and
therefore the votaries of Homoeopathy cannot be accused of unmitigated folly.
The right honorable the Earl of Albemarle presided as chairman ; doubtless
this nobleman, so distinguished in the scientific world, so well qualified, by
anatomical, physiological, nosological researches, to form a sound judgment on
a medical question, considered well what he was about before lending his name
and influence to a system which proclaims the whole science of medicine, as
professed by the Colleges of Physicians and Surgeons, a mistake. The tick-
ets, including wine, for this banquet, were a guinea each, which proves that
the Hahnemannites do not entirely carry out their principle of " similia simili-
bus," as, if they did, they would dine for the good of Homoeopathy on homce-
pothic fare, eat infinitesimal globules of muscular and vegetable fibre, and
drain goblets of proportionate contents, considerably more diminutive than the
acorn cubs of Queen Mab, to whose court homoeopathic doctors might well
enough be physicians. Subscriptions and donations are received for this infin-
itesimal charity by certain bankers ; but neither are these contributions ex-
pected to be infinitesimal, or we should be disposed to beg the Homoeopathic
Hospital's acceptance of the billionth part of a grain of the perspiration of a
sovereign which had been subjected to Mosaic diaphoresis.

[English Journal]

636

The New-Orleans Medical and Surgical Journal.

X. — On the Treatment of Typhus Fever by Sulphate of Quinia,

BY JOHN F. M'EVERS, M. D.

[A. Hester, M. D.

Dear Sir — I beg leave to invite your attention to the following remarkably inter-
esting paper, which I find in one of my exchanges, and trust you will deem it worthy
a place amongst your " Excerpta." The cases reported afford strong support to the
plan of treating Typhus Fever by the Sulphate of Quina proposed by Dr, Dundas
of Liverpool — they will at least serve as a fair off- set to the unfavorable trials pub-
lished by Dr. Bennett and Dr. Christison of Edinburg. It seems that none of these
writers have attempted to cut short idiopathic fevers, whether intermittent, remittent
or continued, by very lage doses of quinine and opium, administered in the forming
stage, and before organic lesion has taken place — yet if further experience should con-
firm the improvement claimed by Dr. Dundas, he ought to be considered a benefactor
of mankind.

Rely upon it, sir, an important revolution has commenced in regard to the pathol-
ogy and treatment of idiopathic fever, and it must progress in spite of prejudice and
ridicule, for truth is mighty and will ultimately prevail.

Yours, truly,

E. D. FENNER.

5 Carondelet street, January 18th, 1853.]

In presenting the details of a few interesting cases of typhus fever treated
in the Cork Fever Hospital, it is due to Dr. Dundas of Liverpool, whose bro-
chure on this subject led to their successful issue, to acknowledge the valuable
service which he has rendered to the profession by the introduction of his novel
and generally successful treatment of this formidable disease.

It would appear, by a reference to Dr. Dundas' pamphlets, that he has had
considerable experience of tropical fevers, and he states, what is confirmed by
other writers, especially by military authorities, that quina will be almost inva-
riably successful in the fevers of hot climates, if administered at an early pe-
riod, and in sufficiently large doses — twelve, fifteen or tweuty grains being a
common dose in these latitudes — repeated at short intervals, say every two
hours, until dizziness of the head or tinnitus aurium be produced ; an effect of
the remedy, however, although characteristic and desirable, which does not
always follow this peculiar mode of administering quinia, and yet the disease
may yield to the potency of a few doses.

By the success which has attended the use of quina in the hands of Dr. Dun-
das, he seeks to establish the identity of the typhus fevers of Europe with the
remittents and intermittents of the tropics ; and in reference to this part of his
paper, it is curious to find, that as far back as 1786, Dr. Skete, who wrote on the
use of bark in fever, broached a similar opinion. He says, " If the remittents
of warm climates are but the continued fevers of this country, in a more vio-
lent degree, and if the effects of the bark are admitted in such remittents, does
it not necessarily follow that bark would be endowed with similar powers, even
in the fevers which every day occur to our notice, I mean those of the typhoid
kind, which are so frequent in all large towns, especially in London and in
Edinburg."

The treatment of typhus fever introduced into practice by Dr. Dundas, and to
which I purpose to call attention in the following observations, consists in the
administration of sulphate of quina in doses of ten grains, repeated every two

Excerpta.

hours, until dizziness of the head, or tinnitus aurium, shall be produced ; or,
should these evidences of the curative effects of the remedy not occur, the me-
dicine is continued until a general amelioration of the state of the patient takes
place; broth and a small quantity of wine being allowed, purgatives, or even
aperients, not being deemed necessary during the treatment. When the dizzi-
ness or the tinnitus are very urgent, Dr. Dundas resorts to an emetic, which,
in my own practice, I have not made use of ; he also states, that if emetics are
had recourse to at an early period, the quina is likely to be more successful.
This treatment is resorted to at all stages of the disease, and frequently in the
advanced periods, under circumstances which would be considered by the ex-
perienced physician as indicative of the worst form of typhus fever ; and this
method of administering quina is almost invariably attended with the happiest
results.

Immediately after having become acquainted with Dr. Dundas' views on this
subject, several persons laboring under bad maculated typhus were admitted
into our hospital, which gave me opportunities of testing the value of his opin-
ions ; and I must confess that I pursued the inquiry with much doubt, as I
looked on some of the cures related by him to be of too marvellous a kind to
justify my adoption of this treatment without further confirmation of its value ;
however, I have now tested the remedy in nine cases, and with the exception
of one, it has been signally successful. The first of these cases was the fol-
lowing,— the notes of which I take from the daily reports of the Fever Hos-
pital.

Pat Ryan, aged 28, a laborer, was admitted into hospital on the 1st January,
1852, from Hop Island. His urgent symptom is headache ; pulse 100; tongue
foul ; skin hot ; had taken purgatives at home, and was treated since admission
in the usual way with salines, ablutions, etc., until the thirteenth day of his
illness, when the usual signs of bad typhus became apparent. On the previ-
ous day his skin was mottled, and now the entire surface has assumed a dusky
hue. Pulse 112, feeble; tongue parched, with sordes on the teeth and lips;
bowels free; some general fulness of abdomen, with epigastric tenderness;
kidneys acting ; headache increased, and raves a good deal. He was ordered
to take ten grains sulphate of quina every second hour, and to have broth and
four ounces of port wine.

The changed condition of this patient at my next visit was most remarkable;
the pulse was considerably reduced ; the tongue was moist and cleaning, in
fact it had lost the dark color and parched appearance it presented the day
before. The man slept ; there was less abdominal fulness and tenderness ; the
kidneys acted well, and the bowels were free. He took sixty grains of quina
without its having produced dizziness or tinnitus aurium. The medicine was
given in the form of mixture with a little sulphuric acid ; the two or three
last doses sickening him a little. I then ordered it in the same dose in the
form of pills, repeating it every three hours, which he bore without sickness.
On this day he bore forty grains, and on the following day he was convales-
cent. It is remarkable that the father of this patient, who was admitted a
few days previously, passed through the same type of fever, and treated in
the ordinary method, and died on the fifteenth or sixteenth day of his ill-
ness.

The second case was that of a young man aged 19, admitted on the 14th of
January, for some days under my care, whose urgent symptom was headache,
with great prostration of strength. On the eighth day his breathing became
very much hurried, unattended, however, with cough, nor did the stethoscope
elicit any abnormal sound ; the man being remarkably pallid, except during
two short exacerbations, which occurred in the twenty-four hours. I ordered
him aromatic spirit of ammonia mixture, with a small quantity of wine, and
a sinapism to his chest.

636

The New-Orleans Medical and, Surgical Journal,

The following morning, on examining the chest, I discovered a purple patch
occupying the part to which the mustard had been applied. His respiration
was improved, but he complained of intense headache. Pulse 108, and fee-
ble : no sleep. The purple patch induced me to institute a careful examina-
tion of his body, and on turning him in the bed, I observed the lower portion of
the back and the nates covered with purple maculae. The case I looked on
then as well adapted for the administration of quina, and accordingly I ordered
ten grains every two hours, together with broth, and two ounces of port wine.
The third dose produced violent headache, with tinnitus aurium, when the
medicine was discontinued.

At my next visit, on the following morning, all his symptoms were improved,
the tinnitus aurium left him in a short time after the medicine was laid aside,
and the headache was greatly mitigated ; he slept and expressed himself much
better. I placed him again on the quina, when the third dose produced the
same results as yesterday, but there was so great an amelioration of all his
symptoms, that I considered him proceeding to convalescence, and gave him
only two grains of quina three times a day, after which his recovery was
rapid.

The next two cases were females, both of whom presented unfavorable
symptoms, and in whom the remedy was equally successful.

The fifth case was one of great interest, exhibiting other symptoms of an
unfavorable nature, in addition to those which have been enumerated in the
preceding.

John Eames, aged 55, a smith, was admitted on the 23d of January, with bad
typhus, having been discharged from hospital on the 3d instant, cured of ordin-
ary fever, with bronchial complication. On the ninth day of his second at-
tack he became mottled, and talked incoherently ; on the tenth day he was not
improved ; he had no sleep ; the tongue was parched and dark, and protruded
with difficulty ; stools involuntary; pulse 120, and feeble. He was ordered to
take ten grains of sulphate of quina every second hour, and to have broth and
two ounces of port wine.

Half past 9, P. M. The quin*i was commenced at one o'clock ; he has
taken fifty grains, and appears improved in every respect ; he is more collected
and speaks with less difficulty; he has had two large voluntary evacuations
from the bowels ; the medicine was directed to be continued.

On the eleventh day, I found that he had taken sixty grains since my last
visit, and although he did not sleep much, and had some singultus in the night,
he was much improved in other respects. The pulse had come down to 100 ;
the tongue was still parched and brown, but he was perfectly conscious ; he
was very deaf, and the maculae were improved in color. On this day he took
only four doses of quina, it having been omitted on account of the ''buzzing,"
as he expressed it, which the remedy produced.

12th day. Pulse 96 ; tongue moist and cleaning ; the bowels open, and
he passes water freely ; to take five grains of sulphate of quina every fourth
hour.

13th day. Pulse 84 ; the tongue clean ; skin cleaning and scaly; conva-
lescent.

I will not occupy time with the details of all the cases in which I have tried
this remedy, but will content myself with the recital of one more case, which
occurred within the last few days, and which I consider in every way worthy
of observation.

Mary Delany, aged 22 years, admitted from Ballincollig on the 10th March,
nine days ill ; headache ; petechia? ; pulse 120 and very feeble ; tongue parched;
got the usual aperient of the hospital.

Excerpta*

639

i Oth day. One stool ; pulse 120, feeble ; tongue parched and split; great
thirst ; respiration hurried ; had no sleep ; she is often flushed, and in the inter-
vals deadly pale; countenance anxious, with the appearance of suffering;
great fulness of abdomen, with tenderness on pressure, especially at the epi-
gastrium; masculae of a dark brown. She was ordered ten grains of sul-
phate of quina every second hour, and to have broth and two ounces of red
wine.

1 1th day. Bowels not open; tongue moist and cleaning ; pulse 100; kid
neys acting.

12th day. At 8 P. M. last evening this girl hecame very stupid ; " did not
know what to do with her head," as she expressed herself; she also became
deaf, and had tinnitus aurium ; this state continued until midnight, with occa-
sional sleep, when she became " lighter," and afterwards slept well ; the kid-
neys have acted, but there is no discharge from the bowels ; she now presents
a totally different appearance from that of yesterday ; she is free from head-
ache, her respiration is natural, the tension and fulness of belly have disap-
peared, but there is some slight epigastric tenderness ; some of the maculse
have disappeared, and the remainder are of a lighter color. The sulphate of
quina to be continued every fourth hour,

13th day. No stool ; tongue clean and moist; pulse 84 ; belly natural
slight epigastric tenderness. The quina to be omitted ; broth and wine to be .
continued ; to have a domestic enema.

14th day. Convalescent.

Since the first introduction into Europe of the Jesuits5 bark, in 1649, the
most celebrated writers extolled its efficacy in the treatment of various diseases,
but especially in fevers ; owing however to some cause or other, it fell into
disuse, and it is probable that this was occasioned by the many failures which
attended its administration ; failures, which I now feel assured were owing
principally to two causes; first, the bark not having been in sufficiently large
doses ; and secondly, the bark not having been always of the genuine kind.
Its use was revived by the celebrated Sydenham, and after the time of that emi-
nent man, its excellent qualities were fully established by Hoffman, De Haen,
Pringle, Gleghorn, and other practitioners of eminence. And it is worthy of
remark, that those who were most enthusiastic in praise of this remedy gave
it in very large doses.

Dr. Clarke, a celebrated physician, who wrote on fever in the year 1770,
was in the habit of prescribing bark in two drachm doses every two hours, and
at the same time of exhibiting it by the rectum in the form of enema ; he re-
lates that on one occasion, in mixing a dose of bark for a patient, he discovered
that the apothecary had by mistake put half an ounce of bark into each pa-
per, instead of two drachms, which he had ordered ; the patient had been
taking this large dose for a considerable time, and got cured of a bad typhus
in consequence. Now, when it is estimated that two pounds of good bark will
yield about two hundred grains of sulphate of quina, it must be admitted that
Dr. Clarke's treatment of typhus was not far short of the heroic method of the
present day, introduced by Dr. Dundas. It is unnecessary to advert to the
fact, that Dr. Clarke's patients were taking a different preparation, possessing,
however, the same active base.

One great objection to its general use in this country, which may be advan-
ced, is the high price of the salt ; but should the remedy be found as efficaci-
ous in the practice of others as by Dr. Dundas and myself, I feel assured that
its use, when applicable, would eventually constitute the true economy of our
fever hospitals.

I have placed these cases and observations together in a very hurried, and,

640 The New-Orleans Medical and Surgical Journal.

therefore, imperfect manner, but the subject I considered to be of so much
importance to the profession, as to induce me to take advantage of the ear-
liest opportunity of bringing forward the results of my experience of this new-
treatment for typhus ; and I do so in the hope, that this notice of the subject,
however imperfect, may induce others to test the value of quina in this dis-
ease, in the large doses recommended.

[Dublin Quar. Jour. Med. Aug. 1852.]

XI. — Speculations on tlie nature and treatment of Tubercular Consumption.

In the January number for 1853 of the Medical Examiner, we read some
suggestions thrown out by Dr. D. B. Phillips, Assistant Surgeon in the United
States Navy, on the nature and treatment of Phthisis, with considerable satis-
faction— so much so, that we'are anxions that our readers should be made
acquainted with Dr. P.'s views on this questio vexata. After apologising
(which was unnecessary) for venturing to express his opinions, he proceeds
to quote Mr. Simon's examination of tubercle, which go to demonstrate that
the matter of tubercle is identical with the matter of condensed fibrinous concre-
ion, Dr. Phillips continues : (Ed.)

May we not assume that the sum and substance of the tuberculous condition
consists in a precipitation of unduly oxygenated fibrinous elements from the
blood, from immediately exciting causes ?

Let us see what arguments or facts can be adduced to sustain such an
opinion. Mr. Simon, in treating of Cyanosis, uses the following lan-
guage :

" There is one signal peculiarity which attends this chronic venous condition of
the blood, and which I nrast not leave unmentioned. Not only in extreme cases~of
Cyanosis, but in all chronic diseases, where from any causes whatever there is defec-
tive arteriaiization of the blood, the patient enjoys one privilege. He is exempt (per-
haps absolutely, but at least all but absolutely exempt) from tubercular diseases. And
as the circumstances which interfere with due arteriaiization of the blood are of the
most various kinds, (some of them acting merely mechanically) so we are justified in
inferring from the exemption just specified, that the condition of the system in which
tubercle is deposited is incompatible with venosity of the blood."

Now, there is one peculiarity of venous blood which alone can account for
the singular fact stated above. Venous blood is much less prone than arterial
to deposit its fibrin. This fact is demonstrated by post mortem examinations,
which always (or nearly always) exhibit fibrinous concretions or deposits in
the arteries and left side of the heart, whilst the veins and right side are free
from them. Mr. Simon also proves the difference in the facility with which
arteries and veins give up this element of their composition. He says, in the
work before alluded to, " I have carried a single thread, by means of a very
fine needle, transversely through the artery and vein of a dog, leaving it there
so that it might cut the stream, and I have done this repeatedly, sometimes in
the femoral vessels, sometimes with the carotid and jugular, sometimes with
the aorta and cava. I have suffered the thread to remain during a period of
from twelve to twenty-four hours. My experiments have given me, as a uni-
form result, that the arterial blood, with the utmost readiness, deposits its fibrin
on the thread ; the venous blood with the utmost reluctancy."

Thus, then, the only condition in which the system seems perfectly exempt

Excerpta.

from the tuberculous deposit, is that in which, from want of proper arterializa-
tion, or oxidation, the blood refuses to part with its fibrin, or else does so with
the greatest difficulty.

Again, in noticing the favorite locality of tubercle, we find it originally com-
mencing on the lungs ; here the blood is necessarily more highly oxygenated
than in any other portion of the body, and here, per consequence, its first at-
tack is made ; and not only in the' lungs, but by preference, in the superior
lobes of the lungs. This arises from the fact, that as a general rule, the upper
part of the chest is less frequently exercised than the lower, and the circula-
tion in that particular portion becoming languid and stagnant, as a matter of
course fibrin is there first effused. Comparatively speaking, consumption sel-
dom attacks individuals whose occupations cause them to make free use of the
muscles of the upper part of the thorax, whereas it is of common occurrence
with those who pursue sedentary occupations, and whose respiration is carried
on chiefly by the diaphragm.

It was formerly charged that tight lacing was a prolific cause of tubercle in
females. Dr. J. M. Allen, Professor of Anatomy in the Pennsylvania College
of Medicine, has informed the writer, that he has frequently examined cases
where this evil habit had been carried to a very great excess ; and that although
the subjects, previous to death, presented every appearance of a scrofulous
diathesis, yet, to his astonishment, instead of finding the lungs filled with tuber-
cle, he has universally found them sound and healthy. He accounts for this
upon the principle, that the stricture upon the diaphramatic portion of the
chest, produced a necessarily increased action of the muscles upon the upper
portion, and that through this means the circulation there was rendered more
active, and tubercle warded off!

It is hoped that no one will infer, that the pernicious and abominable practice
of tight lacing is for one moment advocated ; far from it; but as it sometimes
happens that one evil may point out a remedy for another, so in this instance,
we are taught that one of the best prophylactics against anticipated consump-
tion consists in moderate but frequent exercise of the arms and superior portion
of the breast.

Formerly, fibrin was thought to constitute the great pabulum from which the
healthy tissues of the body were nourished and repaired ; now, however, it is
generally conceded to be a retrograde condition of albumen, and of but little
use in the economy. To those who still maintain the former opinion, a theory
of the kind here advocated will probably appear idle and unsatisfactory; but
to others, the views here presented, defective and imperfect as they are, may at
least seem to claim some shadow of plausibility.

In speaking of the treatment of Phthisis, it is proposed only to hazard a few
conjectures upon the influence of some of the most prominent remedies which
have been, and still are, recommended. One of the most favored, and probably
most effectual remedies in use is the Oleum Morrhuae. This probably acts by
furnishing fatty matter to unite with the oxygen of the blood, in the generation
of animal heat, and thus neutralize any excess; preventing an undue accumu-
lation of super-oxygenated fibrin, and preventing a consumption of muscular
and nervous tissue ; the iodine and bromine contained in it also acting bene-
ficially, by promoting, softening, and the absorption of any concretions already
formed.

The iodide of potassium and nitrate of potassa, with the other alkalies
may also do good, by rendering the fibrin of the blood more soluble, and less
liable to precipitation and coagulation; but in order to produce this effect,
they should be given in large doses, so that some portion of them may be
retained in the circulation, otherwise they will soon be eliminated and carried
off by the kidneys, without exerting any salutary influence. Nutritious and

642

The New-Orleans Medical and Surgical Journal.

unirritating food, by building up the general system, serve also to lessen the
quantity and improve in quality the fibrinous elements of the circulation, and
by contributing tone and strength to the economy, enable it for a longer time
to withstand the noxious influences of any and every kind. Removal to a
warm climate may act in two ways: 1st, by creating revulsion of excitation
from the lungs to the liver; next, by affording less oxygen than would be con-
tained in an equal volume of air respired in a colder atmosphere.

Exercise, as a prophylactic, has been before mentioned ; it is also highly
efficacious as a remedial agent. It should be of such a kind as to call into
action the muscles of the superior portion of the thorax, and in fact all that are
in anywise, directly or indirectly concerned in respiration; and its beneficial
influence is much enhanced by making it of such a nature as to be agreeable
and pleasant instead of forced and obligatory. Riding on horseback has been
most highly extolled by many, its action being probably due to the partial ful-
filment of the above recommendation, by using the hands, arms and shoul-
ders, in the government of the animal, with the reins, and also by improving
digestion, and increasing the general strength. Cases are on record, where
person, who despairing escape from so hopeless a malady, and perfectly reck-
less of consequences, have engaged in pursuits of the roughest, and apparently,
most injurious nature, and who, after travelling on horseback or on foot, and
performing real manual labor, have, to the joyful surprise of their friends, en-
tirely recovered from their dangerous condition, and become both strong and
hearty. Sailors, soldiers, and others, engaged in occupations of similar phy-
sical necessities, although much subject to inflammatory affections of the chest,
are in general less prone to tubercle than those whose condition in life would
apparently better protect them from its ravages.

There are many remedies prescribed and used of a palliative nature, but it
is scarcely necessary to mention them in an article of this kind ; the limits of
the treatise, and time for its preparation, both forbid a more extended examina-
tion of the subject. The ideas here advanced have been hastily (perhaps too
hastily) prepared and presented ; but should they induce investigation, or cast
any light, however small, upon a disease as obscure in its nature, as danger*
ous and fatal in its consequences, the highest hopes of the writer will be
more than realized.

XII. — Boston Society for Medical Improvement.

We select from the American Journal the following interesting items of
practical medicine, as laid before the Boston Medical Society, at some of their
recent sittings.

By the way, this Society has already given to the Profession, through the
Medical Journals, a large amount and a great variety of useful medical know-
ledge.

{Ed. N. O. Med. and Surg. Jour.

Ventral Histerocele. — Dr. Storer reported the case. June 2. Three weeks
since Dr. S. visited Mrs. W., Pleasant street, who expected to be confined in
a few weeks. Upon enquiry being made it was ascertained that the present is
her third pregnancy. The first labor was tedious, and her child was stillborn.
In her second pregnancy, she was delivered at the eighth month, and her child
had been dead sufficiently long to have become offensive to the bystanders.
Since her last delivery, which occurred about a year since, her health had been

Excerpta.

643

poor. She is now languid, pallid, evidently much depressed ; thinks she never
can have a living child.

Upon examining her abdomen, Dr. S. noticed a very singular condition of the
recti muscles, which were separated so extensively from each other, that there
existed a peculiar sacculated appearance of the abdomen, which was strikingly
marked upon any forward motion being made by the patient. This separation
was observed along the whole extent of the linea alba. The projection between
the recti muscles resembled that produced oftentimes by an enlarged ovary,
and the feeling transmitted by examining the hernia was similar to that of an
exaggerated fontanelle, and beneath the finger the number of the several
extremities of the foetus could be as well and clearly defined as if a rupture of
the uterus existed.

The foetal heart was feably pulsating. At the expiration of a week Dr. S.
again saw the patient. She was exceedingly depressed, and remarked that
she had not felt the motion of the child since Dr. S. examined her. Upon a
repetition of the examination, no foetal pulsation could be heard, and it was
concluded that the child must be dead. Dr. Putnam, to whom Dr. S. had
spoken of this, to him singular abdominal hernia, saw her a day or two after-
wards.

Now, June 2, the patient is in labor. During each uterine contraction, the
jprgan was thrust between the recti muscles with great force, and fearing that
serious results might follow, Dr. S. applied a broad swathe around the abdomen.
The labor continued only about two hours, and the patient did not suffer unusu-
ally. The child was still, and exhibited large patches upon its surface, where
the cuticle was entirely denuded. The condition of the placenta, which was
quite small, indurated throughout, and exhibiting upon its foecal surface two
large cysts, each of the size of a chestnut, filled with coagula, readily ac-
counted for the death.

The patient does not remember that any similar condition of the abdomen
existed in either of her former pregnancies ; nor does she seem to have ex-
perienced any decided inconvenience during this last pregnancy, except
during any forward motion. The mere stooping forward to wash the cups
after a meal produced so much uneasiness that she had been obliged to desist
from the operation for weeks previous to her delivery. She cannot recall any
violent exertion by which the separation of the linea alba could have been
induced.

Dr. S. added, that from never having previously met with a case of ventral
hysterocele, and from the fact that those writers who refer to the subject point
to individual cases, which have been published, he inferred its rare occur-
rence.

Recovery from Ascites after Tapping. — Dr. Hay ward, Sen., reported the case.
The patient was an intemperate man, whom Dr. H. saw for the first time in
November last. He was then suffering from ascites. The existence of some
organic disease was at that time supposed by Dr. H. The patient was tapped
in December ; sixteen quarts of serous fluid were evacuated. Five weeks sub.
sequently eighteen quarts were taken from him. The operation was again
performed four or five weeks afterwards, in March, when twenty quarts were
drawn off. Since that time there has been no return of the affection, and Dr.
H. is unable to detect any organic disease. Dr. Hay ward remarked that this
is the third case of recovery from ascitic affection after tapping, that has oc-
curred in his own practice. In one of these cases, the patient had been under
treatment for dyspepsia. On tapping her abdomen, a small quantity only of
fluid was drawn off, but the affection did not recur. In the second case, twenty-
two quarts of serous fluid were drawn off; no effusion followed. The patient

644 The New-Orleans Medical and Surgical Journal.

recovered entirely, and in the course of two or three years gave birth to a
healthy child. Both mother and child are still living.

Dr. Perry mentioned two cases of recovery from this disease after tapping.
In one, the patient was cured by hydriodate of potash, with compression, hav-
ing been previously tapped three times. The other case was of a patient tap-
ped three or four times by Dr. Bartlett of Roxbury, and who afterwards re-
covered. Dr. Perry added, that these two were, not improbably, cases of sub-
acute peritonitis.

Early Menstruation. — Dr. Perry related an instance of menstruation oc-
curring in a child four or five years of age ; the child, to all appearance, heal-
thy, although Dr. P. supposed her to be scrofulous. The tonsils were slightly
enlarged, and she had once had inflammation of the eyes. She had menstru-
ated five times at the regular intervals. Dr. P. recommended no treatment,
but advised country air.

In answer to a query by Dr. Jackson, Dr. Perry stated that the mammae
were somewhat developed, but nothing peculiar was remarked about the pubes.
The secretion had the usual appearance of the menstrual discharge, and con-
tinued for two or three days.

Remedy for the Nausea and Vomiting of Pregnancy. — Dr. Gould spoke of
the application of chloroform to the epigastrium as having been found to afford
prompt and permanent relief in four cases of the above affection. A few drops
only were applied at a time.

Dr. Bigelow was of opinion that chloroform acted as a counter-irritant. He
mentioned the case of a patient in whom vesication was produced by a few
applications of this substance for pain in the side. It had not always been
found to relieve pain. Dr. B. had tried the chloroform ointment spoken of at
a recent meeting, by Dr. Channing, in various forms of neuralgia, and in a few
cases had obtained temporary relief; in no instance was the relief permanent.
Dr. B. doubted the alleged anodyne properties of chloroform, when applied to
skin, as it cannot act through the cuticle.

Dr. Storer remarked, that although nausea and sickness in pregnancy may
be temporarily relieved by this application, he was in doubt as to its affording
permanent relief, the affection being of a sympathetic nature. He considered
the cases reported as possibly exceptional.

Dr. Coale related a case in which the sickness came on when the patient
rose from the horizontal posture. In this instance chloroform afforded imme-
diate relief, lasting three to four hours, when it became necessary to renew the
application.

[At the next subsequent meeting of the Society,

Dr. Alley reported a case of morning sickness in a patient seven months ad-
vanced in pregnancy. Relief was obtained by the external application of chlo-
roform to the epigastrium. The remedy was applied four or five times in the
day, for two successive days, with entire relief to the patient, producing little
or no irritation upon the skin, a slight redness only being perceptible.

In answer to Dr. Storer's inquiry, whether the relief were permanent, Dr. A.
replied, that four days had now elapsod since the disappearance of the symptom.
No other counter irritant remedy was employed.

Dr. Snow asked Dr. Storer if he had' employed, successfully, any other
counter-irritant remedies in this affection.

Dr. Storer had tried the usual remedies of that class, but without expecting,
or having found, permanent relief from them. He had frequently seen tempo-
rary relief follow from the employment of blisters, &c .]

Excerpta,

645

Arsenic in Remittent Fever. — Dr. C. E. Ware related a case of the above
disease, occurring in a lady who had resided for three years at the West, where
she had, three years since, what was called bilious remittent fever. Dr. W.
at first considered it a case of typhoid fever. On the fourth day, however, the
disease assumed the character of remittent fever, and there was yellowness of
the skin, with some tenderness of the hepatic region ; no diarrhoea; a peculiar
chill and reaction occurred every second day!; the chill lasting for halt an hour,
and the febrile reaction for four or five hours. Dr. Jackson saw the patient
on the tenth day, and suggested arsenic, in the dose of six drops of Fowler's
solution three times a day. The first attack, after commencing this remedy,
took place on the subsequent day, and was quite severe. Twelve drops were
now given every five hours. The patient suffered no farther attacks, and be-
came at once convalescent.

Accidental Salivation. — Dr. Coale mentioned a case of this affection, in
which periodica] exacerbations took place twice in twenty-four hours, viz., at
one in the morning, and at the same hour in the afternoon. Quinine was given
with success. The patient had not had intermittent fever, but had suffered from
fever in the East.

Dr. Durkee stated, that in the above case, which had been sent to him by
Dr. Coale, the occurrence of salivation was from the application of an oint-
ment made of 3 v of white precipitate to f iij of lard. This was applied pretty
freely to the throat and lower part of the face, which parts were the seat of
psoriasis guttata, and salivation followed on the fifth day. This was the first
case of salivation produced by this remedy that had fallen under Dr. Durkee's
notice.

Dr. Coale mentioned another case of salivation produced by the application
of the " black wash" to the throat.

July 12. — Almost Complete Occlusion of the Vagina. — Reported by Doctor
Hayward, Sen. Dr. H stated^that he had recently operated in a case of this
nature. The patient had always menstruated regularly, but with pain. She
had no suspicion of her condition until marriage, which took place about a year
since, when sexual connection was found impracticable. On examination, a
septum was found at some considerable distance from the external orifice, with
an opening in it so small as only to admit, and that with difficulty, a small
probe. A director was afterwards introduced, and then an attempt was made
to carry in a bistoury, which was finally successful. A catheter was now
passed into the urethra, and the septum incised in all directions, except tow-
ards the bladder. After this, Dr. H. was enabled to introduce the finger, and
to pass it completely around the os tincae.

This is the fifth case of occlusion of the vagina that has occurred in his
own practice. Two of these were cases of imperforate hymen. The third
was a case of congenital malformation of the vagina, successfully treated by
an operation. Another was one of occlusion produced by sloughing, after
instrumental labor. This last was also relieved by an operation, the patient
having since had a living child. In the cases above reported, the septum was
unusually firm, cutting like tendon. On examination, six weeks after the ope-
ration, it was found that it had afforded complete relief.

Unusual quantity of Liquor A?nnii; the Placenta and Foetus both healthy in
appearance. — Reported by Dr. Storer. The patient was in her third pregnancy.
When in her first, she was enormously large, and was delivered of a dead
child in the sixth month, the amniotic fluid being in great abundance. In her

G46

The New-Orleans Medical and Surgical Journal.

second pregnancy, the abdomen was also greatly distended, and the labor
came on in the eighth month ; the child dead, as before. In the present case,
the labor came on in the eighth month ; there was great distension of the ab-
domen, and the child, as in the two former instances, was stillborn. A pe-
culiarity of this case was, the healthy appearance of the child and of the pla-
centa, in each instance ; a condition not usual in cases where the liquor amnii
is in excess.

Early Menstruation. — Dr. Minot reported the case of a woman, twenty-three
years of age, wno had recently consulted him for headache, having been bled
one year before for the same trouble. The patient was run over by a wagon
when 9 years old, since which she has menstruated regularly, the function be-
ing always attended with much pain.

Obstinate Diarrhoea preceding and following Labor. — The case was reported
by Dr. Storer. The patient was first seen by Dr. S. ten days ago. She had
had diarrhoea for a fortnight, and expected to be confined in one month. On
the second day after his visit, she was taken with pains resembling those of
labor, and at the end of the second day labor came on, it being the eighth month
of her pregnancy. On the following day she had nine discharges from the
bowels. Lead, opium and catechu were given, without effect. Finally,sulphate
of copper, in the dose of one sixth of a grain, combined with ten or twelve drops
of laudanum, was administered. The physician feared a fatal result. The
patient has, however, been improving for two days past, having had but three
discharges in the last 24 hours.

26th. Dr. Storer reported his patient entirely recovered.

Deafness produced by Quinine. — The case was reported by Dr. Hay ward,
Sen. Twelve grains of the sulphate of quinine were administered, in the space
of twenty-four hours, to a patient, who had been afflicted with rheumatism. In
forty-eight hours after commencing its exhibition, he complained of deafness.
There was no dizziness. No tinnitus aurium. In twelve hours after having
abandoned the use of the medicine, hearing was entirely restored. Dr. H. said
he had frequently given quinine in much larger doses, e. g., two scruples
and one drachm in the course of the day, but had never before noticed the
above effect. The quinine in this case was given combined with gentian. No
other symptoms.

July 26. — Microscopic Anatomy of the Foetus. — Dr. Durkee exhibited seve-
ral preparations from a foetal subject, about five or six months old, which only
weighed twenty-six ounces, and which he had injected with colored size; the
blood-vessels of both crystalline lenses were injected, and their branches could
be seen radiating from a comparatively large trunk, and traversing the lens
in every direction, untU they were lost near its periphery. In mounting these
two specimens, the epithelium between the lens and its capsule had not been
disturbed, but could be seen apparentiy in its normal condition. The mem-
brana pupillaris were exhibited, showing the beautiful arrangement of its
fibres, and the ciliary arteries, with their branches and anastomosing extre-
mities injected.

The pupillary membrane, examined in situ, through the cornea, appeared
to be about the sixth of an inch across from point to point of its border, and to
consist of an entire web of fibres; but upon removing it, and placing it on a
glass slide, a narrow aperture or slit, as if made with the point of a lancet, cut-
ing through its central portion, could be seen by the naked eye, and was about

Excerpta.

€47

a. line in length. In looking at the membrane through the microscope, an arterial
branch which has been injected may be seen running parellel to each lip of the cen-
tral opening just mentioned, and sending off at right angles several exceedingly mi-
nute twigs, which also divide and subdivide, until they finally inosculate and form a
chain of loops, and thus the central aperture appears to be made. A somewhat sim-
ilar inosculation of blood-vessels is seen in the border of the sclerotica at its junction
with the cornea, and also in that part of the choroid membrane surrounding the optic
nerve as it penetrates the sclerotic coat in the back part of the eye. In the two
latter instances, however, the openings are circular, while that in the pupillary mem-
brane is a mere slit.

Judging from the specimens now exhibited, it would seem that the pupillary mem-
brane must be formed antecedent to the formation of the iris, as scarcely a rudiment
of the latter can be found ; and how it can be said that the former arises from the lat-
ter, it is quite difficult to understand ; yet Todd and Bowman appear to be of that
opinion.

Dr. S. also exhibited several teeth taken from the same subject. They were ex-
tremely small, some of them not so large as a common flaxseed, and they consisted
of mere pulp; yet their cell structure could be seen and the nutrient blood-vessels
were perfectly injected, so that the microscope brought them distinctly into view. A
large number of hairs, with their related follicles and glands, removed from the eye-
lids of the same foetus, were also examined by the gentlemen present.

Puerperal Convulsions. Death of Patient undelivered. — Doctor Storer was called
in consultation with another practitioner, at a quarter past ten o'clock at night, July
]9, to a patient in puerperal convulsions. She was attacked at six in the morning,
and had had repetitions of the attacks during the entire day, at longer or shorter in-
tervals ; about half an hour generally intervening between them ; she had been bled
at two o'clock in the afternoon, and again at six, about 20 ounces each time, but still
her convulsions continued.

The patient, a woman about twenty years of age and at her full period of preg-
nancy, had the aspect of approaching dissolution ; she was perfectly unconscious ;
the surface of her body was cold and damp ; the pulse exceedingly feeble. While
examining her she had a terrific convulsion.

Upon examination the Doctor found the os uteri slightly open, just allowing the
index finger to pass and to ascertain that a head presented. He advised that prema-
ture labor be attempted ; there appeared but little chance that it could be accom-
plished, but no other alternative presented itself. The membranes were readily
ruptured.

Prevented by unavoidable professional engagements from remaining with the wo-
man, Dr. Storer requested the attending physician to watch her through the night,
and should she die, as it appeared probable she would, undelivered, to open the abdo-
men immediately and remove the foetus.

Doctor Storer was informed the next morning by the medical gentleman in attend-
ance, that the convulsions continued to recur, after he left the patient, about every
twenty minutes, until a little after 12 o'clock, when she died, a few minutes after
the cessation of a paroxysm.

Dr. immediately opened the abdomen of his patient, and removed a child,

with its extremities so contracted and rigid as to be straightened only by the applica-
tion of a considerable amount of force ; and besides this, its surface was livid
throughout. Examining again, he removed a second foetus, somewhat less rigid than
the former.

Doctor Storer stated, that in this case, as well as in that reported by him on the
evening of June 14th, he supposed the child would most probably be dead, inasmuch
as the convulsions had existed so long a period previous to an attempt being made to
produce delivery ; but he requested that the abdomen of the woman might be opened
as soon as she ceased to breathe, as the living foetus has been extracted after the death
of the convulsed mother.

048

The New-Orleans Medical and Surgical Journal.

Speaking of the treatment of puerperal convulsions, Colombat observes (American
edition, page 646) : " Should the mother have breathed her last during the progress
of the labor, the Csesarian operation ought to be performed, notwithstanding the
very slight chance of success there may be in such an attempt to rescue the life of the
child."

XIII. — Death resulting from a Biliary Calculus lodged in the Hepatic Duct,

BY DR. TRACY E. WALLER.

The deceased was an industrious, stirring man, the father of a large family and
highly respected. He had lived until recently in the lower part of Pennsylvania and
the adjoining part of Maryland ; a decidedly bilious district. He was fifty-seven
years of age, and for many years, according to the statement of his family, had been
subject to severe attacks of bilious colic. These attacks, I judge from the descrip-
tion given of them by his wife, were probably icterus calculosus, or similar to the one
which caused his death. There was undoubtedly chronic disorder of the biliary or-
gans, at least of the liver, and he had been troubled very much a long time with in-
digestion. A. few days previous to his last attack he had been exposed to inclement
weather, and complained of being unwell. I was sent for on the night of February
24th, 1850, and found him in great pain and suffering ; this was mostly in the right
epigastrium, though there was some pain and tenderness in the abdomen. As I had
never attended him before, I made enquiry respecting his previous health, etc, and
after an examination of his case, concluded there must be acute disease of the liver,
and probably inflammation of the bowels and their investing membrane. My treat-
ment of course was antiphlogistic. The next morning, February 26th, I was engaged
in an obstetric case, and sent for Dr. Salsbury, of Dover, who had been his physi-
cian for some time previous. He visited him about nine o'clock, and found him in a
sinking condition. At 1 1 o'clock he expired.

I obtained permission from his family to make a post mortem examination, and
about twenty-four hours after death, with the assistance of my friend, Dr. S alsbury,
the autopsy was made. I shall briefly describe the post mortem appearances in the
order of dissection.

Thorax. Nearly the whole of the right lung was hepatized ; the patient had an
attack of pleuro pneumonia about fifteen years since, followed by an abscess, which
accounts for the condition of the lung ; the left lung and pleura were normal ; the
heart contained a small quantity of serum, and presented marks of recent slight in-
flammation in the right auricle ; otherwise it was normal.

Abdomen. The stomach was nearly normal, with some inflammation near the py-
lorus. The duodenum had more than half its surface inflamed ; the small intestines
and peritoneum in the same condition, and covered in many places with yellow bile;
the pancreas inflamed and adhered ; there were several adhesions to the folds of
the peritoneum ; the lower half of the right and inferior lobes of the liver was much
inflamed and indurated ; the hepatic duct was highly inflamed, distended and soft-
ened. It was ruptured about one inch from the liver ; and just below the opening
contained an ovoid biliary calculus, three fourths of an inch in length and a fraction
over a half inch in diameter. It must have been lodged there for several days, as by
the lymph, etc., thrown out in consequence of the inflammation, it was completely
imbedded in the duct ; this at once explained the presence of bile in the cavity of the
abdomen, which had been quite unaccountable before we came to the duct. It also
enabled us better to understand the reason of the great extent of inflammation ; the
bile was extensively diffused over the bowels and parieties of the abdomen, and the
fascia along the linea alba had been tinged by it of a yellow color.

This is probably a new case. Watson records something like it as regards inflam-
mation. He says : " Sometimes the gall-stone makes its way by ulceratioa, through

Excerpta*

649

the contiguous structures, and so is discharged outwardly or into the bowels." In
this case there could have been no remedy ; the stone completely blocked up the
passage of bile from the liver, and if ulceration of the duct had not taken place, in-
flammation, terminating in death, would have been the result. Watson has so well
and fully described the various effects on the system of the passage of gall-s ones,
that I prefer referring you to his work to detailing them here : as my objects in this
communication are chiefly to elicit information respecting the main feature in my
case, namely, the lodgment of a calculus in the gall duct ; and to suggest farther in-
quiry into the primary causes of biliary concretions.

This, it appears to me, is a question of great importance, and would give scope for
extensive research and experience. Will not some fellow of the college undertake
the investigation ?

(Philadelphia Medical and Surgical Journal.)

XIV. — Vinegar as a Remedy for Madness.

Dr. Andouard makes the following remarks on this subject in the " Cotnptes
Rendus."

M. Baumes reported the following fact, fifty years ago, to the Academy of Me-
dicine at Montpelier, of which institution he was secretary, and one of its foun-
ders]

A* sow, having been bitten by a dog, became mad ; the owner, so far from destroy-
ing her, confined her in a pen, and through a hole in the boards, supplied her with
vinegar ; the sow drank of it and got well.

In support of this fact, we may quote from the Dictionary of Medical Sciences,
in the article Rage, where it is said that ' ■ a man with the first symptom of madness
drank freely of vinegar and was cured."

To these two facts I will only add here, that Pliny remarks, that swallows' nests,
steeped in vinegar, are good for madness ; this author is prolific in receipts for mad-
ness, and I quote this because of the vinegar.

Is this product of vinegar really efficacious in madness ? I mention these cases in
order to draw the attention of observers to the facts.

Vinegar, in order to avoid the repugnance which the patient feels for liquids, may
be exhibited in a solid form. The most simple and economical mode is to soak bread
in vinegar. This avoids all repugnance. Bread has nothing connected with it cal-
culated to irritate the sufferer. (Ibid.)

XV. — Luxation of the Sacrum.

An instance of this very rare accident is reported by M. Foucher in the Revue Me-
dico-Chirurgicale, in the case of a man who endeavored to commit suicide by throwing
himself beneath the wheels of a heavily loaded wagon. After death, the chief ap-
pearance was a dislocation of the sacrum forwards into the cavity of the pelvis. The
ilia were also fractured. Similar cases are on record ; one, for instance, in which the
accident occurred from the falling of a sack of wheat upon the pelvis, and another
was published by M. Laugier, in 1850. In some other examples reported, the luxa-
tion seems to have been the result of disease. (Am, Jour. Med. Scien.)

Jpart &l)irJL

REVIEWS AND NOTICES OF NEW WORKS,

I. — Midwifery and the Diseases of Women. A Descriptive and Prac-
tical Work. By Joel Shew, M. D.

Children, their Diseases and Management. By Joel Shew, M. D.
Author of various works on Hydropathy.

Wythes' Pocket Dose Book. Author of " The Microscopist," etc.

The writer of the two volumes which stand first in order, is a strong
advocate of the water treatment, recommending it somewhat indiscrim-
inately in the multifarious diseases to which women and children are
subject.

Upon any other grounds than the special advocacy of Hydropathy,
it were difficult to imagine what motive could have induced Dr. Shew
to put forth these two volumes ; so many elaborate as well as abridged
works upon the subjects treated of being already at command, and
upon which the seal of medical approbation has been placed by com-
mon consent. It will not be argued that in no instance has the author
ventured upon an unbeaten course, or stepped aside from principles,
which few if any medical men for the last quarter of a century have
ventured to gainsay, and the salutary effect of which upon individuals
and upon widely extended communities, have been hailed with the
joyful acclamations of thousands in every rank and sphere of life. Nor
will it be argued that in such dissent upon particular points has the

Reviews. — Addresses — Reports, etc.

651

philosophy of the author failed to succumb to genuine philanthropy, and
an earnest desire to rid humanity of one of its direst calamities — we
refer to small-pox. To suppose an individual opposed to vaccination,
and at the same time opposed to small-pox, would be an anomaly in
terms, since by vaccination we employ the greatest safeguard and pre-
ventive to the accession of that loathsome disease.

In the XVIII. Letter, upon diseases of women, we find the subject
of vaccination disposed of in the following language : "I am opposed
to vaccination at all times. It is better, I believe, to live carefully
and consistently in all respects, and trust nature to the results. There
are many objections to vaccination, which I need not here mention.
Pregnant women especially, who are necessarily, in the present state
of things, more than others, subject to inflammatory diseases, and less
liable, when attacked by acute disease, to recover therefrom, should
not be vaccinated."

In raising objections to vaccination during pregnancy, Dr. Shew is
not alone ; of this number also is Prof. Meigs, who strongly condemns
the practice, at the same time acknowledging that small-pox is exceed-
ingly pernicious to pregnant women ; but if at times great distress and
serious consequences ensue from vaccination during this time, it is
equally true that still more fearful and alarming ones might await the
party exposed to contagion, without the conservative influence of vacci-
nation ; its paramount importance has long since been acknowledged —
settled — beyond disputation ; we therefore pass on again to dissent
from the views of our author, with regard to the employment of chlo-
roform in labor; and although he does not stand, like Adam's recollec-
tion of the fall — alone — in his views, we must assign him the minority
side of the question, in his opposition to the use of chloroform in labor.
" Pain is a natural condition of the puerperal state," it is remarked*
Pain is also a natural, a constant accompaniment of external injury, —
of surgical operations, — and yet how eagerly do men and women em-
brace the glorious opportunity vouchsafed to them by the introduction
of anaesthetic agents, to free them from the thraldom of racking pain,
and often, whilst cheated of their fair proportions, lose the senses in
some sweet oblivious dream.

Is it because the pain of child-birth is a natural condition that we
are to avoid anaesthesia? If so, its efficacy having been fully and fairly
proven, we are to be so wmiatural as to discard one of the most valuable
agents of modern times, and in our backward step, let suffering human-

6-32

The New-Orleans Medical and Surgical Journal.

ity groan under the severity of the knife, howsoever graceful and dex-
terous the operator.

In the Letter upon the hygeine of nursing, are found some useful
suggestions, particularly for mothers, who, abounding in the whims and
vagaries of the age, sometimes seem to fancy themselves automatons,
and their offspring as too tender sapling for the wind of heaven to light
upon ; the too common fashion of transferring the duties of the mother
to the wet-nurse, is justly censured.

u I would have every one of you to understand that the health of the unnatural
mother, who wil not nurse her child, suffers from her not fulfilling the order of
nature in giving suck. Her system must inevitably get harm from not allowing
it to go through the period of lactation naturally. Her life of dissipation, too, is
poorly calculated to contribute to health, compared with staying at home and fulfill-
ing the order of nature — as God designed she should do. But she gets her re-
ward even here ; there is no period of woman's lifo in which she has so great en-
joyment, such perfect physical health, as when she is nursing the offspring of her
own blood. Her shattered nerves and broken health are poor pay for the so.
called enjoyments of a dissipated life."

With some plain dietetic rules, which are more frequently given[than
profitably received, Dr. Shew leaves the nursery for other branches of
his subject.

Over-eating and drinking are doubtless fruitful sources of disease,
and our author with propriety recommends, in many cases, abstinence
instead of medication, and free ablutions with cold or tepid water ;
bathing and vegetable diet have been found by the writer highly valua-
ble in cases of sterility. The following are some of the cases taken
from his note-book :

f< A few months since one of my patients, a gentleman of this city, informed me
that a lady relative of his, with whom I also am acquainted, had been married about
eight years, remaining, much to her sorrow, childless. She experienced frequent
miscarriages, accompanied with much general debility. About two years since the
subject of water-treatment came under her observation. She at once commenced a
course of bathing, with due attention to regimen, etc. She became much improved,
and in due time bore a healthy, well-formed child. She attributed this most desir-
able result to the effects of water in restoring her general health.

Another lady remained without offspring fifteen years after marriage. Her hus-
band, in building a new house since the introduction of Croton water into this city
erected also convenient bathing fixtures ; the lady practised perseveringly a course of
bathing and became much improved in her bodily health. She too was at length
blessed with offspring, and as she believed, in consequeuce of the course she haoVpur-
sued in restoring her general health.

Reviews. — Addresses, Reports, etc*

653

I have known and heard of numbers of cases in which, by a prudent course of
bathing, exercise, etc., the use of a plain and unstimulating diet, and the observing
of a proper temperance in the marital privileges, persons have borne children when
most earnestly and by a great variety of means that object had been sought in vain.
Yet be it ever remembered, that little is to be expected from either water or diet
without strict temperance in all things."

The vegetable diet, so called, is very favorable to reproduction in the human spe-
cies. See how Ireland, a small island comparatively, sends its inhabitants all over
Great Britain and the wide extent of the United States. Yet the mass of the Irish
people, as every one knows, subsist while in their own country mainly on potatoes
and sour milk, or a diet equally simple. The celebrated Dr. Cheyne remarked,
from much experience, that the total milk and seed diet [meaning by seed farinace_
ous substances generally] persevered in for two years, was in almost all cases suffi-
cient to enable those who are barren to become pregnant by the appropriate
means.

Fortify and invigorate the general health, observing at the same time the strictest
temperance in all things. These are the means by which to overcome that, to many,
unfortunate state, barrenuess.

In the Management of Labor, we find nothing new, either before or
after delivery. Indeed, after carefully consulting Ramsbottom, Blun«
dell, Denman, Dewees, and others, the subject will be found so well
discussed, as to leave little for the reader to gain from any manual.
It was evidently the design of Dr. Shew to render the little volume
practical, and the several parts of it easy of solution ; with this view
he has always been plain in his mode of expression—indeed much more
plain than forcible. It is equally obvious that the book is intended to
enforce a special kind of treatment — that of water ; and hence the
general medical reader is in danger of saturation from a too great abun-
dance of the limpid element which flows in upon him on all sides ;
hydropathists will find in the author a firm believer, and a modest ex-
pounder of their views — qualities which frequently are cast aside long
before pen is committed to paper.

We will now turn to the volume on Children, their Diseases and
Management. The alarming mortality in the stages of early life, as
shown by mortuary returns in different countries and cities, is sufficient
to awaken investigation, and stimulate to efforts for its amelioration.
According to the annual report of the Registrar General of births, deaths
and marriages in England, presented to Parliament, for the years end-
ing June 30th, 1833, and June 30th, 1839, it appeared that more than
one third of the total number of deaths occurred under two years of age,

854

The New-Orleans Medical and Surgical Journal.

the exact proportion being 342.54 per 1000 of the deaths registered.
Taking the city of Manchester, England, alone, the picture is still more
frightful, for out of every 1000 deaths of males, 496 were of children
under three years. Since the period referred to, it is believed that the
rate of mortality has considerably diminished.

In our own country, statistics upon this subject have not been so
generally made ; particular sections only having very reliable and de-
finite data. In the city of New York, in 1847, nearly one half of the
whole mortality occurred amongst children under five years of age. It
is, in the opinion of Shew, mainly, though not entirely, through our ig-
norance and mismanagement in regard to fulfilling the laws of Divine
Providence, that we have such a result, and the means to be employed
for its removal almost entirely within man's control. It seems to be
with the view of disseminating knowledge on the subject of health, and
" as a guide for families and physicians," that the present volume was
undertaken.

Judging from the tenor of the second chapter, we should imagine,
that to many spinster members of families much that is contained in it
will be most acceptable, the subject of marriage, especially those which
occur in early life, receiving something more than doubtful approval.
Were we entirely devoted to the selection of passages for the dissemi-
nation of useful knowledge in passing through the pages of Dr. Shew,
we should pass over the present one in silence ; but as his opinions are
not rendered exclusively for family use, we may venture to insert his
own words : " On the whole, then, it will be observed that I am in fa-
vor of what would be termed early marriages. These, it must be ad-
mitted, are sometimes precocious, and too early formed ; but as a gene-
ral rule, I regard it better, if the parties are in suitable circumstances,
have good health, and are inclined to this step, as most persons under
such auspices are, to marry at a time that would generally be regarded
as early. In so doing, the health and happiness and well being of both
parents and children will, I am very confident, be ultimately much en-
hanced."

The evil consequences resulting from precocious unions are not con-
fined to the parents, who, in addition to the probability of shortening
their lives, and the female especially exchanging the ruddy bloom of
youth and health, and the elasticity and vigor of mind and body, for fa-
ded beauty and premature decay, entail upon their offspring, in numer-
ous cases, an enfeebled body, perhaps " sent before its time into this
breathing world," and with a mind as fragile as the body.

The injurious consequences of early marriages being known to all,

Reviews.-*- Addresses, Reports, etc.

655

and experienced by many, we are at a loss to imagine by what process
of reasoning the author has so confidently arrived at the opinion that
early marriages will increase the " health and happiness" of those who
embark in it, and that the issue of such marriages will possess greater
vigor ; but as this may have been intended for family use, they are en-
titled to the full benefit of the act, and all the joy which Dr. Shew can
bestow upon them.

The treatment recommended for the diseases of children, is but the
counterpart of that which is sought to be enforced in the diseases of
women, viz : cold water.

Much space is given in the present volume to Diarrhoea and Dysen-
tery. To subdue the inflammatory action of the latter disease, it is
affirmed, that the most powerful and efficient mode is, to employ that
simple, cheap and universal" remedy — cold water ; by its application,
fever and pain are both mitigated, and if thorough work be made in
cooling the bowels by the "cold hip-bath," pain and tenesmus will
cease, and tormina and writhing will quickly pass away upon the child
being held in a " tub of cold water." Other antiphlogistic modes of
treatment are said to be inferior to this, and leeches, opium and calo-
mel, recommended by Sydenham, Elliotson, Dewees, Watson, and
others, as vastly less efficacious. Having said this much in favor of
the water treatment, (and none will deny that it is a most valuable and
powerful agent in surgery, as well as in the treatment of many medical
cases, especially as an auxiliary) we are somewhat surprised to find
that the author cannot speak more encouragingly of its result, upon
which certainty to some extent, in all cases, we must rely. Upon this
head it is remarked, " Whether the patient can live, is another question;
but if death even must be the result in any given case, it is certainly
very desirable that we make this death as easy as may be. This every
parent can well appreciate."

A similar course is recommended in the treatment of Cholera Infan-
tum; for in this disease, " as in Dysentery, the great thing is to prevent
all undue heat." It is with a view of preventing the rapid abstraction
of heat, that the warm bath has been suggested, upon good authority ^
in this fatal disease, which, under any system of medication, it must be
admitted, is exceedingly intractable.

As in other infantile diseases, so in Croup, which is regarded as "the
most rapid and severe of all inflammatory diseases," water "consti-
tutes the best of all known methods" of cure." " I do not know," re-
marks Dr. Shew, " in the whole range of medical experience, any thing
which is more calculated to make a man thankful, than to be possessed

658

The New-Orleans Medical and Surgical Journal.

of a knowledge of so good a remedy as cold water in this disease."
Had Dr. Shew placed before us the success attendant upon the water
cure, as well as that attendant upon other modes of treatment, in a
given number of cases of Croup, which must certainly be included in the
" whole range of medical experience," he would have placed us under
many obligations for his assiduity, and he might also have placed a mo-
tive before the reader to become a convert to his doctrine ; in this,
however, he might have been restrained from prudential reasons.

Before closing our rather hasty remarks upon Dr. Shew's volumes,
we are glad to have met upon ground which will be undisputed, and
upon which we may wash, and hope to be clean.

In the treatment of Scarlatina, the writer has given full play to his
aquatic propensities, and writes under this head : " Use cold water fear-
lessly in the way of ablutions, pourings, wet sheets, compresses, clys-
ters, drinks, etc., and fear not."

Hoping that Dr. Shew may cure all his patients with water within
and without, we will pursue the subject no further.

The Physician's Pocket Dose and Symptom Book will sometimes, as
one of reference, be found useful, pointing out the therapeutic effect of
many articles — those most ordinarily in use — of the materia medica,
and at the same time indicating the dose for adults and the substances
with which they are incompatible. A. much better repository, for all
practical purposes, for the information contained in books of this char-
acter, is the head of the practitioner, so that it may always be at com-
mand; besides, the effect and dose of medicines is the appropriate study
of its followers, when in incipient pupilage ; its more important use is
in readily showing what substances are incompatible, a circumstance
sometimes lost sight of in prescribing.

The little book is of such convenient size, that for those whose love
for globules is not too exclusive, the whole might be taken at few doses
It is worth the having, and can be found at T. L. White's, 105 Canal
street. G. T. B.

New Orleans, January 25, 1853.

Reviews.— Dr. Ricord on Syphilis.

657

II. — Operative Surgery Illustrated : Containing more than 1900 Engra-
vings, including 200 original, and 50 Colored Drawings. With Ex-
planatory Text. By R. U. Piper, M. D. Also a Chapter by Bige-
low, on the use of Ether in Surgery. Boston, Ticknor, Reid <k
Fields. 1852.

Well executed sketches and faithful pictures will greatly assist, it
must be admitted, a better understanding of most of the surgical ope-
rations now made ; but the study of plates and drawings, however ac-
curate and well finished, can no more make a good Surgeon, than the
study and contemplation of the riggings of a man of war can an ex-
pert sailor or seaman. The eye may assist the hand; but the latter
must be trained to the use of the knife, before an operation can be
executed with skill, safety and dexterity.

Besides numerous engravings, drawings, etc., the work gives a brief
but clear description of the several important operations that may fall
in the path of the Surgical Practitioner. Without such descriptions,
the engravings, not by any means well executed, could only serve to
confound the student and embarrass the operator.

We have a decided objection to the size of the book ; and unless the
Profession judges its merits by its weight, it will be a longtime before
the first edition is exhausted. In a word, nearly every thing attempted
in this work, has been much better executed in books which treat of
Surgery and Surgical Operations, and we cannot for the life of us see
in what way the Profession is to be benefitted by such publications.
The printing and paper are excellent, and on this account we find no
fault with the publisher. If the work does not prove useful to the Pro-
fession, it may adorn a library, and we therefore advise our readers to
purchase it of J. C. Morgan, Exchange Place, New Orleans.

III. — Letters on Syphilis. By Ph. Ricord, Chirurgien de l'Hospital
du Midi, Chirurgien. Consultant du Dispensaire de Salubrite Pub-
lique, Membre de PAcademie Nationale de Medecin, de la Societe
de Chirurgie, etc., ect.

The name of Ricord is identified with the progress of Syphiliography
all over the civilized world. By his ingenious and varied experiments
on the living subject with the venereal virus, he has cleared up many

658 The New-Orleans Medical and Surgical Journal.

doubtful points ; established principles for our guidance, and taught us
something definite as to the nature and action of this subtle poison. By
his labors he has immortalized his name, and received the homage
which he so well deserves, of all the votaries of Venus from the four
quarters of the globe.

These " Letters" were originally addressed to M. Latour, Redacteur
en Chief of the Union Medicale of Paris, and are written in that easy,
fluent style so characteristic of the genius of M. Ricord. They will
be found full of practical instruction and elucidation of one of the most
deeply interesting subjects of the day — Syphilis and its kindred affec-
tions.

The effects of syphilitic diseases upon society — upon mankind, and
upon posterity, are little less grave than phthisis pulmonalis ; since both
have a wide-spread influence — both may be entailed upon succeeding
generations ; both may be propagated from father to son, and from the
mother to the daughter ; both may contaminate the blood ere it has
acquired the aptitude for functional purposes, and become blended and
incorporated into the very tissues of the body, there to lurk until some
fortuitous circumstance, or favorable moment, for them to develop their
specific nature. We are not prepared to endorse all of Mr. Wilson's
views, in regard to the incurability of syphilis, when once fully introdu-
ced into the system ; but we are convinced of the subtle nature of the
poison, and the extreme difficulty with which it may be expelled, parti-
cularly in certain constitutions.

The work before us contains a long and well written Introduction,
addressed to M. Ricord by M. Latour, the able editor of the Union Me-
dicale, in which these "Letters" originally appeared. Speaking of
what the French call clandestine prostitution, M. Latour addressed Ri-
cord in the following glowing and pertinent strain :

"Two facts which are equally important, but between which we can per-
ceive no connection, strike the attention of all who are at this time studying sy-
philis in its relation to public hygiene.

On the one hand — and I speak especially of civilians, for it appears that in
the army the case is different, since the adoption of certain measures in 1842—
the number of syphilitic men does not sensibly diminish.

On the other hand, the number of diseased prostitutes has been considerably
reduced ; to such a degree, indeed, that according; to an official communication
which I recently received from the learned M. Trebuchet, chief of the sanitary
bureau at the prefecture of police, the dispensary contains at present scarcely
one diseased girl in four hundred.

Reviews— Dr. Ricord on Syphilis.

659

Whence arises this apparently contradictory result — this decrease of the
disease at its very source, while the number of syphilitics is now almost equal
to those which formerly existed?

This circumstance, we are everywhere assured, is attributable to the fact that
the sources of syphilis have been shifted. The disease, so happily checked in
public prostitution by the judicious and efficacious measures adopted by the
administration, has tended to concentrate itself entirely in that continually aug-
menting class of the female population which practice clandestine prostitu-
tion, against which the police, believing itself to possess no control over it,
leaves the public without protection.

Who is better adapted than yourself, my dear friend, with so many opportu-
nities for observation in a vast nosocomical clinique, and in an immense civil
practice, to inform us how much truth there may be in the assertion ?

If all that I have stated be true, is it x\o\ for the interest of public morals and
health to enlarge the definition of prostitution ?

Is there not ground for calling the most serious attention of the vigilant ma-
gistrates of the city to the necessity of reaching this prostitution, which is a
thousand times more dangerous than that which is legalized, inasmuch as it is
more attractive ? By this means syphilis is contracted and extensively propa-
gated with frightful rapidity.

This prostitution is called clandestine — a singular term, dear friend, to desig-
nate that which is exhibited in the galleries of the theatres, in the public balls,
in all those places of pleasure, in fact, which are at present no more than im-
mense brothels! What! does the police think it has the right of imprisoning
in Saint Lazarre, without process and without judgment, an unfortunate girl,
inscribed upon its books, who may in some point have contravened the severe
regulations to which she is subjected, and thus to disarm the poor girl ; wThile a
cohort of women are left with impunity to compromise the fortune and the
health of young men ! What! has the police the right to enter at all hours
those houses where imbeciles and dupes give themselves up to the chances of
dice, while it pauses undecided upon the threshold of a courtesan, who poisons
ten or twelve lovers a day ! What, then, is prostitution, if it is not ' the noto-
rious commerce of one's charms ?' Some one says there must be provocation
upon the public street. That is a bad test of prostitution. The best frequented
houses take good care to give no direct provocation ; else would they be at once
deprived of their prudent and wealthy custom ; and yet the police holds them
none the less under its beneficent supervision. And what is the tendency of
those strangely lascivious dances at the balls of Asnieres and Mabille — of those
nights at the opera, where provocation lurks in every thing — in the costume,
in the gestures, and in the voice — and of those nocturnal orgies in the private
saloons of some famous cabarets, the description of which casts into the shade
the frightful picture of the manners of the Romans at the decline of the Em-
pire ?

What pen is more competent than your own, my dear friend, to describe the

660 The New -Orleans M&dical and Surgical Journal.

ravages of this clandestine prostitution, the misfortunes it occasions, and the
troubles it excites in families? Who is better adapted than yourself to trace
the syphilitic poison from its present numerous sources, insinuating itself into
the ranks of the best classes of society, infecting the purest and chastest spouse,
rendering her barren, or unfit to carry to term the fruit of conception ? Who
better than yourself can trace the affecting history of him who has inherited sy-
philis—the subject, I know, of your most earnest researches ? Who, in fine, is
better adapted than yourself to make known to the administration the only sure
and efficacious prophylaxy against the disease — the one which must bo entrusted
to medical science ?"

We fear the preceding picture of the ravages of syphilis through the
means of clandestine prostitution, are not restricted exclusively to the
great and dissipated capital of France. America, too, contains more
than one such within her borders. Is New York, Philadelphia, Cincin-
nati, not to mention others, less amenable to the charge of secret pros-
titution than gay and fashionable Paris ? Are we so much better than
our trans-Atlantic neighbors, that the evil here spoken of needs no cor-
rective ? If it be less in magnitude, it must surely be commensurate
in its disastrous effects in individual cases.

Having given a rapid sketch of the state of syphilography at the time
he entered the walls of the Hospital du Midi, M. Ricord proceeds to
remark as follows :

"That which was the most of all necessary was to investigate the cause of
syphilis.

Had it a special virus ? Or, were venereal accidents the result of a common
cause ?

For this research and this study, two methods of observation presented them-
selves to my mind.

The first was the pure and simple observation of phenomena ; a method prac-
tised by our predecessors, but which had conducted them to such contrary opin-
ions. This method was followed by Devergie, and is not unlike that adopted by
Vigaroux, by Blegny, etc., in their report, for example, of the case of three
officers, all of whom having connection with the same young girl affected with
a discharge, became infected ; the first with a urethritis, the second with a
chancre, and the third with warts. It is true that Devergie failed to afford in-
formation on one small point, that of the precise state of the young girl, whom
he did not examine with the speculum.

Evidently, this mode of investigation was worn out, and could conduct only
to vagueness and confusion.

The second method was more satisfactory to my mind ; it was besides more
in accordance with the demands of modern science ; it seemed to me to open

Reviews. — Dr. Ricord on Syphilis.

661

a sure way to the study of the cause of syphilis, and of necessity to lead to in-
contestible results — I speak of experiment.

I laid down for myself the following- conditions :

To obtain syphilitic virus from a known source.

To place it upon a region of the body open to observation.

To note its effects.

You see these conditions could be fulfilled by experiment alone.

But experiment had already been interrogated, and by it people had arrived
at contradictory conclusions. When John Hunter said yes, Caron, Bru, Jour-
dan, Devergie, and M. Desruelles, said no. What was the basis of affirmations
so opposite, when the same method of investigation had been employed ? I did
not then know — I have since learned. What my reason then told me was,
that a series of rigorous and well-conducted experiments must lead to precise
results; and the dissensions of experimenters did not dishearten me.

These researches were difficult and delicate. Convictions, and I dare say
courage, were needed to undertake them ; it was necessary to be certain of
clearly'appreciating the circumstances under which I was about to act ; it was
necessary to rely upon previous experiments ; it was particularly necessary
to rely upon the purity of intention, and the strict testimony of the con-
science-

I did not, in fact, content myself with the great name of Hunter — with the
experimenters cited by Bell — with the work of Hernandez, so honorably recog-
nized by the Academy of Besangon — with the authority of Percy, and other
names equally renowned ; but I wished to study the question in itself — to place
myself in the conditions appropriate, to a veritable inventor ; in fact, to assume
myself alone all the responsibility of the results.

How was it necessary to proceed in this experimentation ?

I could inoculate a healthy individual — I could experiment on the patient him-
self."

This our author proceeded to accomplish, and with what benefits to
science and to humanity, the Profession is already fully advised. Un-
like some, M. Ricord did not inoculate the healthy with the venereal
virus ; he only tested the experiment on those already the victims of the
poison ; he varied his experiments, and noted the results, which have
long since been laid before the world. He found, in the course of his
observations, that the multiplication of the points of inoculation did not
aggravate or add to the consecutive accidents of syphilis — " that in re-
ality he would give him no more disease — that he would not augment
the gravity of the accidents with which he was already affected — that
in a word, he would not expose him, as already stated, to any additional
chances of secondary infection." These humane considerations being

662

The New -Orleans Medical and Surgical Journal,

well established, M. Ricord, with that love of true science, so peculiar
to men of intellect, entered upon the boundless field of experiment —
the rich fruits whereof may be gathered from these interesting letters.
M. Ricord first directed his attention to blenorrhagic infection. " Wo-
men," he observes, "frequently give Menorrhagia without having it"
This form of the disease, he says, is as rare in woman as it is frequent
in man ; and he adds, " I do not think I go too far in saying, that wo-
men give twenty clapps to one which they receive." M. Ricord ridi-
cules the doctrine advanced by M. Cazenave — that many women, under
the influence of utero-vaginal catarrhs, can have sexual relations with-
out communicating infection — provided they are not heated, to use his
language, to boiling points ; provided they are not raised, so to speak, to
virulent red heat." Our author explains this fact in this wise — hear him:

"Is it not more simple to understand, and more rational to say, that with a
less degree of excitation the secretions are less irritant, and that custom can
produce an immunity from these secretions in some persons; as it were, by a
kind of acclimation ?

It is thus, as I have frequently seen, that a married woman may cohabit
with her husband without communicating any thing to him; but let a lover
supervene, and the latter contracts a blenorrhagia. The husband was accli-
mated, the lover was not.

When one studies blenorrhagia without prejudice, without preconceived
ideas, he is forced to confess, that it is frequently produced under the influence
of most of the causes which determine inflammations of other mucous mem-
branes.

The experience of Swediaur is at hand to prove this. This observer injected
a volatile alkali into the urethra, and it produced a blenorrhagia. Does this
experiment prove that we can always and at will produce blenorrhagia by irri-
tating injections ? No; any more than one can always produce a coryza by
the same means, an opthalmia, etc. For blenorrhagia, as for any other inflam-
mation, there is required a pre-existing predisposition — that immense unknown
which governs all pathology. This is proved by the circumstance that ble-
norrhage is not always contracted under the same conditions in which it is most
evidently communicable. Without this happy immunity, which the absence
of the predisposition gives, blenorrhagia, already very common, would be still
more so."

M. Ricord, to confound some of his learned colleagues, who advoca-
ted doctrines adverse to his own on the specific nature of blenorrhagias,
resorted to the following stratagem to show up his opponents. Hear
him and judge for yourself, reader :

" A man presented himself at my consultation, with one of the best character -
ized blenorrhagias. He declared to me that he had only had connection with

Reviews, — Dr. Ricord on Syphilis.

663

one woman, and this was his wife or mistress. The man was alarmed and dis-
quieted. He brought with him the woman from whom he had contracted the
disease, and she protesting her innocence, in concert with the patient, supplica-
ted me to submit her to the most rigorous examination. This examination,
made with all the rigor and attention of which I am capable, showed me the
sexual organs of this woman to be perfectly healthy. There was nothing, ab-
solutely nothing, in the deepest folds of these organs, which could explain the
Menorrhagia of the man. I requested the woman to walk into another room?
and, alone with the patient, I exhausted all possible means, the details of
which I will spare you, to arrive at this certainty. The patient had had con-
nection with this woman alone ; it was only in this intercourse that he could
have contracted his disease.

I reassured the husband or lover ; I exculpated the wife or mistress ; but then
I asked them to become accomplices of the little stratagem which I am about to indi-
cate.

I sent them both, (separately of course) to this or that learned colleague, whom I
knew to be^in absolute opposition to me on the question of blenorrhagia. I said to the
patient : Ask this question distinctly, Is my blenorrhagia syphilitic ? I said to the
woman : Ask boldly, Can I give blenorrhagia to a man?

The couple returns ; the man with a diagnosis thus arranged : Syphilitic blenorr-
hagia ; follow the treatment ad hoc.

The woman had this indication : The perfectly healthy state of the genital organs
permits me to state that madam cannot have communicated a disease with which she
is not herself affected.

It is not a unique and isolated fact which I cite to you, my dear friend ; the experi-
ment I have renewed frequently, and often enough to corroborate my convictions and
to assure my conscience.

What do these facts signify ? That the cause of blenorrhagia cannot always be
known ; that this malady may be produced by the causes common to all inflamma-
tions, provided there be a predisposition to it ; but that the most special agent of ble-
norrhagia is the muco-pus furnished by the inflamed genito-urinary mucous mem-
branes."

M. Ricord notes it as his honest conviction, that simple blenorrha-
gia is completely distinct from syphilis, so far as relates to the causes
which produce it. After discussing at some length the nature, the source
and the specific character of blenorrhagia, M. Ricord closes this part
of his subject with remarks on the treatment of this disease. He be-
lieves that the abortive treatment by injection, in the early stage of ble-
norrhagias, so far from producing strictures of the urethra, constitute
the " best prophylactic treatment of these strictures ;" and that the
quicker these discharges are arrested, the less danger of organic le-
sions of the urethra. These lesions, like others of the mucous mem-
branes, are caused by inflammations ; cure the inflammation, and you

664 The New-Orleans Medical and Surgical Journal.

abolish all danger of stricture. We are not to infer, because strictures
do sometimes succeed to the use of injections, that these latter have
caused the former. By no means.

The remainder of the book, from page 94, is devoted to the consider-
ation of pox — syphilis. In this he aims, as he tells us, to seek the spe-
cific causes of diseases reputed to be venereal — to study with rigorous
closeness their mode of action, in order finally to arrive at a more ex-
act knowledge of their consequences and treatment. In reply to those
who deny the efficacy of venereal inoculation, as a test of the genuine
disease, M. Ricord holds the following language :

" But to this objection relative to the inutility of inoculation, I have a further reply
to make. I have inoculated the same patient, hundreds of times, with the pus of
chancre, the pus of balano-posthitis, the muco-pus of urethral Menorrhagia, the muco-
pus of blenorrhagic opthalmia, and with the pus furnished by phlegmonous inflamma-
tions of other regions ; and while the pus of chancre invariably produced chancre, the
other kinds remain inactive. What other proof can be desired and what solid ob
jections can be urged agait st it 1

But it has been objected that the effects produced by inoculation on an individual
already infected prove nothing as to the nature of the cause: in other words, that
the inoculation of an individual with the secretion furnished by himself leads to no
important conclusion, because infection first assumed, every wound can and must be-
come syphilitic.

Here is a singular error, which may be attended with serious consequences ; a dan-
gerous prejudice, which we are astonished to see still brought forward by those who
make pretensions to accurate observation. The facts I am about to mention demol-
ish this objection completely. I well know that the cases of leech-bites, which have
taken on the characters of venereal ulcers, have been cited. But be persuaded, my
dear friend, that these bites, like every wound made in a syphilitic patient, become
venereal ulcers only in so far as they afterwards become affected by the contagion.
Apply leeches where there is no contact of inoculable pus ; bleed syphilitics as much
as you will ; make any experiment you please ; and if there is no virulent contact,
virulent transformation will be impossible. Among the numerous observations I have
made which substantiate the truth of this assertion, I will relate the following from
the clinique of the Hospital du Midi.

At the time I had a female ward, a patient affected with a phagedenic chan-
cre of the vulva, with abundant suppuration, was seized with a pain in the tibio-
tarsal articulation. Leeches were applied over the painful point. Some days after-
wards the patient complained of the bites ; and it was easy to see that some of them
had undergone a veritable transformation, and had become true chancres. For a
moment this result might have been attributed, and some did attribute it to the
state of the general system. As for myself, I had not the least doubt as to the nature
of this transformation. First — all the bites were not ulcerated. Again — the patient
was seized with similar pains in the opposite articulation ; a new application of
leeches was made, due care being taken to guard against all injurious contact —

Reviews. — Dr. Ricord on Syphilis.

665

and this time, therefore, not one of the bites experienced the least syphylitic trans-
formation.

I made a still more conclusive experiment. I have frequently experimented with
the pus of a chancre on a patient laboring under the influence of a constitutional
syphilis produced by a preceding contagion ; various punctures were made ; and
here, as in other cases, the matter from the chancre alone gave rise to positive re-
sults.

Whatever then may be said to the contrary, it is unjust to compare a syphilitic
patient to a leathern bottle full of virus, which is allowed to escape by the smallest
puncture : the figure is poetical ; but it is not true.

But in order that these results may be invariably obtained, our reason assures us
at once that the virulent matter must be taken from a chancre at a certain period —
that is to say, at the period of progress. It is very easy to conceive this fact ; and
I am sure I shall not weary you in seeking to make you understand, that if you take
the pus from the surface of an ulcer which is in the way of reparation and cicatriza-
tion, you will have a simple, inoffensive pus, which will give you negative results ;
and that the same accident, experimented on at two different stages of the disease,
will lead to different results. You will conclude, then, with all candid observers,
that there is no contradiction, no uncertainty in the results of these experiments ;
and that I have not resorted to evasion, to subtlety of doctrine, for the purpose of
explaining facts which seem to bear against the principles which I maintain, and
which are maintained by Bru.

When Bru failed to inoculate the pus of chancre, it was for one of two reasons :
Either he made an error in the diagnosis, or he took the pus from chancres at the
period of reparation. There is no way of escaping fiom this dilemma ; for I repeat,
and am ready to prove the fact to the incredulous, if any such there now are, the
pus of chancre is inevitably inoculable."

The part about to be inoculated requires only a slight solution of
continuity, without the aid of any physiological act, to produce the in-
evitable effect. The matter from a venereal chancre, like that from a
vaccine pustule, will produce its specific effect after it has become tho-
roughly dried ; but to take effect, the virus, like that from the vaccine
scab, must be reduced, moistened, and introduced, at some point of so-
lution of continuity.

M. Ricord admits the following variety of chancres : Simple chan-
cres ; inflammatory chancres, with an evident tendency to gangrene ;
indurated chancres.

Our author believes in the unity of the poison, and that the variety
of chancres which he has specified, is due to accidental circumstances
— to hygienic conditions — and to the constitutional peculiarities of in-
dividuals.

But we must here bring to an abrupt close our very meagre sketch
of these truly remarkable Letters on Syphilis by M. Ricord. They

666 The New-Orleans Medical and Surgical Journal.

are full of practical hints and important deductions ; abound in episodes
as racy as they are truthful, and always intended to enforce a principle
or clear up doubts. These letters will be found as fascinating as some
of the best written novels of the day, and hence we advise our young
friends to call on T. L. White and buy the work.

Before we dismiss these Letters, we will sum up, in the language
of M. Ricord, the Therapeutics of Syphilis at the present day.

1st. Abortive treatment applied to the chancre as soon as pos-
sible.

2d. Mercurial treatment reserved for the indurated chancre and for
secondary accidents.

3d. Iodide of potassium applied to tertiary accidents.

4th. Mixed treatment, by mercury and the iodide of potassium, in
tardy secondary accidents, or when tertiary accidents exist at the same
time.

Such are the therapeutic means advised by M. Ricord in the several
stages of this cruel disease.

IV. — Prospectus of the Virginia Medical and Surgical Journal. Edited
by Drs. Geo. A. Otis and H. L. Thomas.

These Editors inform us that the first number will be issued in April,
1853. It will be published monthly, each number to contain eighty
large octavo pages. The object of the Journal is to diffuse medical
knowledge and intelligence — to advance the science and to support the
dignity and interest of the medical profession. Terms, five dollars per
annum.

We shall have more to say, when the first number comes to hand, on
Journalism and medical literature.

Reviews. — Db. Yandell's History Louisville University. 667

V. — History of the Medical Department of the University of Louisville:
An Introductory Lecture. By L. P. Yandell, M. D., Professor.
1852.

After welcoming in a few graceful words the class assembled in the
medical hall of the University, Prof. Yandell proceeds to compare the
three " learned" professions, one with the other. " Medicine alone,"
says he, " rests upon observation and experience. Law and Theology
are historical and dogmatical." In law every thing depends upon pre-
cedent and authority ; upon precept and decision. In Theology every
thing is based upon authority, and that authority is the Bible. But in
Medicine, truly observes Prof. Y., authority is (should be) worth but lit-
tle ; we have no traditions nor decisions which have the binding force
of law; no records of infallible wisdom, but the book of nature.
Medicine is experimental and demonstrative. " The eye of the natur-
alist, the laboratory of the chemist, and the knife of the anatomist, are
all requisite to its advancement."

Books, although useful in the study and practice of medicine, still
the student of our science must investigate nature — study her mode of
operating — make himself acquainted with the laws by which she is
governed — judge correctly of her power for good as for evil — in healthy
and diseased states.

The eloquent lecturer next proceeds to demonstrate the antiquity and
necessity for medical schools, as auxiliary to a better knowledge of
medicine ; he then gives a rapid sketch of the origin of medical teach-
ing in this country ; says Dr. John Morgan is entitled to the credit of
having founded the Medical Department of the University of Pennsyl-
vania, which was first organized in 1765, while Dr. Benjamin Franklin
presided over the College. In 1782 a Medical Faculty was attached to
Harvard University ; and in 1804 Dr, John Davidge laid the foundation
of a medical school in Baltimore. Previous to the establishment o^
these schools, every American student repaired to Europe to acquire a
knowledge of his profession. In the fulness of time, as the population
began rapidly to increase in the West, the necessity for another medical
school, to supply the wants of the people, was seriously felt, when, in
1817, Doctors W. H. Richardson, B. W. Dudley, Daniel Drake, Joseph
Blythe, and James Overton, formed themselves into a Faculty of the
Medical Department of Transylvania University, at Lexington.
From this time forward, with many changes in the Faculty, and always
a small and fluctuating class, - for several of the first years, the school

668

The New-Orleans Medical and Surgical Journal.

gradually rose in public confidence, and ultimately attained much popu-
larity in the South-West. About the year '35-6, the Faculty of ihe
Lexington School began to feel and acknowledge that to maintain the
medical department in the ascendency which it had for some time en-
joyed over the one in Cincinnati, it must be transferred to a more de-
sirable location — at some point where the facilities for the study of dis-
ease, and the pursuit of anatomy would be much greater ; and Louis-
ville was the point chosen by common consent, to which the School
should be transferred. But when the moment arrived for the transfer,
both the citizens of Lexington and the Trustees of the University in-
terposed objections, and positively interdicted the removal of the Medi-
cal Department. This led, as is well known, to some difference among
the Professors, and finally to a dissolution of the Lexington Faculty —
one half, viz : Doctors Dudley, Richardson and Short, remained attached
to the Lexington School ; the remaining three, Doctors Caldwell, Cook
and Yandell, accepted chairs in the Louisville Medical Institute, which
had been recently chartered by the Legislature of Kentucky.

Prof. Yandell gives an interesting account of the gradual growth of
Louisville Medical Institute in public estimation ; the slow but steady
increase in the number of students ; when finally, in 1845, on the eighth
session of the Institute, the Kentucky Legislature granted a charter
for the University of LouisVille, of which the Institute was constituted
the Medical Department. The first class that assembled in the Medi-
cal Department of the University numbered 353 students, and the se-
cond reached 406 ! The School has had many difficulties and obstacles
to oppose its progress ; but we believe now it is as well established and
perhaps as prosperous as any medical institution this side the Blue
Ridge. It has an able Faculty and every facility for imparting a sound
medical education. We thank Prof. Y. for his favors.

VI. — The Druggists 's Receipt Book, comprising a copious Veterinary
Formulary, etc., etc. By Henry Beasley. Second American from
the last London edition. 1853.

To the planter, farmer, cuisinier, veterinary surgeon, and all others,
this book must be invaluable, as it furnishes the preparations, doses, and
mode of action of all such medicines as may be required in the treatment
of the diseases of all our domestic animals.

For the dealers in Perfumery it must prove highly advantageous,

Reviews. — Dr. Carpenter on Human Physiology. 669

because it lays down all the formulas for the compounding of this branch
of the trade. Nor does the book neglect to enlighten us on the science
and art of preparing Cosmetics — that essential part of the toilet of many
of our fashionables — we regret to say, of both sexes. Dietetics, Beverages
and Condiments also receive more than a passing notice. In a word,
the book furnishes a species of information of the first importance to
almost all kinds of trades, occupations and professions. It should be
found in the library of every family from Maine to Oregon. J. B. Steel,
60 Camp street, has it for sale.

VII. — Principles oj Human Physiology, with their chief applications to
Psychology, Pathology, Therrpeutics, Hygiene, and Forensic Medi-
cine. By William B. Carpenter, M. D. F. R. S. F. G. S., etc.,
etc., etc., etc. 5th American from the 4th London edition, with 314
Illustrations. Philadelphia, Blanchard & Lea, 1858. pp. 1090.

This, the 5th American edition of Dr. Carpenter's great work on
Human Physiology, has been entirely remodelled, and in many parts
re-written and fashioned according to the present progressive state of
physiological science, as it exists in every section of the scientific world.
Dr. C. has aimed to give a 'practical direction to the science of Physi-
ology, which has never been attempted in similar works on the same
subject ; how far he has succeeded the studious reader will be made
acquainted as he turns over the thousand pages of this vast work.
Many portions of the book have been entirely reconstructed — others
curtailed — such, for example, as related to the " Place of Man in the
scale of being," and such other portions of the work as treated of Com-
parative Physiology ; whilst the sections which treated " of the differ-
ent branches of the human family and their mutual relations," have been
much amplified and extended in all that relates to man.

The Second Chapter of this edition, which treats of the " Chemical
Components of the human body, and the changes which they undergo
within it" is introduced for the first time, and will be found replete with
instructive matter, more particularly in that portion of the chapter
which treats of the respective relations of fibrin and albumen to the
nutritive process, and of the former to the gelatinous tissues ; not for-
getting to glance at the recent discoveries of M. Ch. Bernard in re-
gard to the elaboration of sugar and fat by the liver.

The consideration of the chemical components of the organism and

670 Th New-Orleans Medical and Surgical Journal.

the important part performed by these in the vital processes, led the
author naturally to consider the " Structural Elements of the human
body, and the vital actions which they exhibit, constituting the Third Chap-
ter of the work, which is now introduced for the first time in the book.
In this chapter are also discussed the general doctrines of cell for-
mations and of vital force, in their application to human physiology.

Chapter Fourth treats of the physical characters, chemical compo-
sition and vital properties of the blood ; most of which has been en-
tirely re-written, and greatly extended beyond the limits which has
heretofore been devoted to the same subject in any former edition. In
accordance with the suggestions thrown out by certain friendly critics,
Dr. Carpenter tells us he has reversed the previous arrangement of the
chapters which treat of the functions in detail — the organic being dis-
cussed before the animal functions ; and this arrangement involved other
changes in the plan of the work, which it is hoped and believed will add
materially to a better understanding of the subject.

It can scarcely be necessary for us to notice all the improvements
and changes introduced in the present edition ; these will be developed
as the reader scans the work ; but the greatest addition will be found in
Chapter XIV., which goes at considerable length into the Functions of
the Nervous System — both in its psychological and physiological rela-
tions.

We think we have said enough (although we have but glanced at a
few of the additions and improvements to be found in this edition) to
prompt the student of Physiology to make himself well acquainted with
its contents. We are gratified to perceive that British authors are at
last about to do justice (though tardy, it may be,) to the valuable labors
of our fellow countryman, Dr. Bennet Dowler. In this last edition,
Dr. Carpenter has not only referred to the writings of Dr. D., but has
copied into the context of his work his experiments on post mortem
contractility, published some years since, we believe in this country.
The cultivators of science should eschew all envy and seek the truth.

White, 105 Canal street, has this valuable work for sale.

Reviews.— -De. Tully on Materia Medica.

671

VIII — Materia Medica or Pharmacology and Therapeutics. By Wm.
Tully, M. I). November, 1852.

If we are correctly advised, Dr. Tully has written a valuable treatise
on Materia Medica, which will be published in parts, this being the
first of the series. From the " Introduction," which is elaborately pre-
pared, we are enabled to gain some insight into the peculiar views of
Prof. Tully — these will be found in some respects original, if not always
correct, and hence, we think the work, when completed, will attract
some attention.

The author has long enjoyed a high reputation among his profes-
sional brethren of New England, and this effort will add still more to
his popularity as a sound thinker and a good writer. His views of the
mode of action of remedies, difler in many particulars from his prede-
cessors and his cotemporaries. Setting aside some very just strictures
on the Materia Medica of Cullen, Murray, and others of that and later
epochs, Dr. Tully devotes a large portion of this Fasciculus to the con-
sideration of the Modus Operandi Medicaminum, as he expresses it,
and defines " Health to consist in a natural, easy, regular and perfect
discharge of all the functions of every part of the living animal sys.
tern;" whereas he defines "Disease, in the extended acceptation of the
term, to consist in any deviation from health, either in structure, or
function, or both, in a part or the whole of a living system ; or it is
some vitiation of the actions or sensations, or both in conjunction, of
the living, acting, sensitive solids." These definitions, always defective
in themselves, and seldom satisfactory, will however be found as near
the truth as others that have been enunciated on similar points. Dr.
Tully continues, "The particular unnatural, uneasy, irregular, and im-
perfect discharge of the functions of one or more of the parts of a living
animal system, or in other words, the particular deviation from health,
either in function or structure, or both, in one or more of the parts of
a living animal system, constitutes the pathological condition. Except
from mechanical lesions, as appears to me, there is no such thing as a
primary structural disease. It will at once bo obvious, that without a
mechanical lesion, a change of structure cannot possibly be produced
except by a change of function. A medicine, or in other words a re-
medy for disease, is an agent or process, which, by proper application
or employment, changes, counteracts or overcomes disease, and either
directly restores the functions to a healthy state, or produces such a con-
dition merely as will readily become a healthy state, on the discontin-
uance of the remedial agent or process. Healthy function, then, con-

672

The New-Orleans Medical and Surgical Journal.

sists in right actions or motions, and right sensations, in the living so-
lids. Disease consists in wrong or vitiated actions or motions, or wrong
or vitiated sensations, in the living solids. Medicinal influence consists
in the counteraction of wrong or vitiated actions or motions, and of
wrong or vitiated sensations in the living solids. When no wrong or
vitiated actions or motions and no wrong or vitiated sensations exist
in the living solids, the greatest portion of medicinal agents, when given
in medicinal doses or quantities, are capable of producing temporary
deviations from right actions or motions, and right sensations, in the
living solids, but usually in too slight a degree, and of too transient a
character, to amount to disease.

The actions of medicines will be influenced by so many and divers
agencies, that it is exceedingly difficult to lay down any positive law or
line of action by which they shall be constantly governed. Thus
Ipecac, generally, and in most persons, acts in large doses as an eme-
tic ; yet we have, with others, known it, although given in emetic doses,
actually to allay nausea, and determine sound and refreshing sleep,
when opiates, etc., had totally failed to produce any such result. This
fact, we have noted, in the case of young persons, in several instances.
We might multiply almost ad infinitum anomalous and exceptional ca-
ses of this kind ; every Physician in large practice can readily recall
similar cases.

We are free to confess that the profession knows, in reality, little or
nothing of the modus operandi of therapeutic agents; from the most
obvious effects of medicines, we are too ready to conclude that we ap-
preciate their full influence upon the economy ; forgetting in the mean-
time, all those molecular changes which are undoubtedly brought about
by every perturbating agent which may be applied to, or introduced
into the living system. To know that one medicine acts as a cathartic,
another as a narcotic, and so on, is indeed to restrict our information to
a few simple self-evident facts ,* but to go beyond this limit — to fathom
the mysteries of therapeutics, hie opus, hie labor est — this is the gordian
knot, which as yet we are not prepared to untie. Perhaps the day is
not distant, when, by the aid of organic chemistry, we may be made
acquainted with the influence of medicinal substances upon the organ-
ism ; at present, however, we must be content with the knowledge of
a few isolated facts, and look forward to the future for more reliable in-
formation on the subject of therapeutics. The great discrepancy of
opinion which every where exists on the peculiar action of most medi-
cinal substances, proves conclusively how little we actually know of
therapeutics.

Reviews. — Dr. Tully on Materia Medica. 673

Dr. Tully thinks that the primary manifestations of the operation of
all medicines are either — -1st, on the nervous system generally, or some
subordinate part of it ; 2d, the primary digestive system ; 3d, on the
secernents and absorbents, or the glandular system ; 4th, on the san-
guiferous system ; 5th, on the reproductive system.

This to us is about equivalent to saying, that the primary operation
of all medicines is made manifest somewhere, or upon some parts of the
animal system ; in other words, we are absolutely ignorant of the action
of " all medicines ;" and why not confess the fact — why not plead igno-
rance of these great mysteries ? Thus far all theories on the subject
are but idle speculation, and every writer on the subject fixes the pri-
mary action of medicines- — somewhere of course — one upon the nervous,
another upon the sanguiferous system, whilst a third, a little nearer (he
truth, perhaps, will have it that the primary action of medicine is ex-
erted upon the mucous membrane of the stomach, and that a certain
influence, according to the specific character of the agent, is propaga-
ted to either the nervous or sanguiferous system, or to both, according
to the states of the system and individual susceptibilities. We must
either claim to know nothing or every thing on this subject ; a medicine
either acts or it does not act ; if it acts it must modify the vitality, (mean-
ing thereby its state of being) of the part or parts ; this modification of
vitality is not restricted to a particular tissue, structure or part, but em-
braces all the tissues, structures, etc., of the part or parts upon which the
primary impression is made. Again we will hear Dr. Tully :

"It is a plain question of faet, and not at all a matter of theory or hy-
pothesis, viz : Do medicines that are taken into the alimentary eanal produce
their medicinal effects by an impression and influence made first upon the
inner parieties of the stomach and upper and smaller intestines, and thence
propagated by the nerves to the parts or organs in which we perceive the pri-
mary manifestations of operation ; oris the medicine in its entire state, or its
activ proximate principle unchanged, received into the mass of the circulat-
ing fluid, by which it is carried about, until it is brought into actual contact
with the parts in which we perceive the primary manifestations of its opera-
tion ? Does the very small number of medicines which are capable of being
injected into the blood-vessels with impunity, produce their medicinal effects
by an impression and influence made first upon the inner parietes of the blood-
vessels,and thence propagated by the nerves to the parts or organs in which we
perceive the primary manifestations of operation; or is the medicine in its en-
tire state, or its active proximate principle, unchanged, carried about by the
blood until it is brought into actual contact with the parts in which we perceive
the primary manifestation of its operation 1 Do those medicines which are
applied to the skin and the bronchial membrane produce their medicinal effects
by an impression and influence made first upon these parts, and thence propa-

,674

The New Orleans Medical and Surgical Journal.

gated by the nerves to the parts or organs in which we perceive the primary
manifestations of their operation ; or is the medicine in its entire state, or its
active proximate principle unchanged, actually absorbed into the blood by the
skin and bronchial membrane, (two non-absorbing textures) and carried about
till it is brought into actual contact with the parts in which we perceive the
primary manifestation of its operation ?

Some medicines appear to be absorbed in quite small quantity into the blood-
vessels, and this in their entire state. It will be obvious that elements can be
thus absorbed only in their entire state ; but several salts of inorganic and che-
mical origin are absorbed in the same manner. Vegetable and animal organic
compounds are very rarely if ever absorbed entire into the blood-vessels. It
is only some one of their proximate principles, and that often in a much modi-
fied state, that is ever found in the blood, or emunctories, except the lower and
larger intestines. Coloring and odorous principles are almost exclusively the
principles of vegetable and animal organic compounds that are ever found to
be received into the blood-vessels from the alimentary canal. These are rarely
the medicinally active principles of vegetable and animal organic medicines.
When the odorous principles of vegetable and animal organic medicines are
absorbed from the alimentary canal into the blood vessels, they are commonly
perceived subsequently, either in the urine, the sweat, or the halitus from the
lungs. When the coloring principle of vegetable and animal organic medi-
cines are absorbed from the alimentary canal into the blood-vessels, they are
commonly perceived subsequently in the urine only, of all the excrementitious
secretions."

When the work shall be published entire, we shall be better enabled
to judge of its peculiar merits.

IX — A Discourse on the Times, Character and Writings of Hippocrates.

By Elisha Bartlett, M. D,, Professor of Materia Medica, and

Medical Jurisprudence.
In his discourse upon the writings and character of Hippociates, Dr.
Bartlett has placed before us a paper of some interest, containing his-
torical facts and annotations from the writings of the father of medi-
cine, who is first introduced to the reader in a Thracian city, at abou t
the age of thirty, at the bedside of the young Silenus, watching stead-
fastly and anxiously the development of the gravest symptoms of his
case, and having made these known 'to his afflicted wife in " a few piou s
and kindly words, we are quickly carried to chambers of other sick
friends of the young Physician, who, to the duties of his vocation, su-

Reviews. — Dk. Bartlett on Hippocrates.

675

peradds those of "guide and philosopher;" high powers are also as-
signed to him in didactic and persuasive oratory.

The author of the Discourse briefly alludes to many of the works
of Hippocrates, giving many of his sound views upon medical subjects^
and lightly commenting upon some of those, which, at the present day,
would not be considered so sound. Having quoted many of the sen-
tentious, and sometimes dogmatical Aphorisms of the Greek, the writer
passes on to notice the surgical acumen of the subject of his discourse,
and although centuries have rolled on, and modern improvements and
modern innovations have veiled much of the past in oblivious night,
and although Greek and Roman eloquence can no longer enchain the
minds, and lead captive the hearts of assembled thousands, we have
still imperishable monuments handed down to us in their books.

The following passage will have as great force now as at the time
in which it was written : " It is necessary," says Hippocrates, "to ac-
custom one's self to the use of either hand, and of both at the same
time — having for rule, utility, suitableness, promptness, dexterity, ele-
gance and facility." . ..." In the application of a bandage, the con-
ditions to be fulfilled are promptitude and dexterity, which prevent
pain, — ease and elegance."

Outstripping his contemporaries, yet exposed to their censure, fre-
quent controversies arose ; upon one of these the writer of the Dis-
course remarks : —

" One of the curious facts in connection with the treatise on Articulations,
is that of a warm controversy between Hippocrates and several of his contem-
poraries, in relation to dislocations of the thigh. Ctesius of Cnidus, physician
to the court of Persia, and principally known by some historical fragments,
blames Hippocrates for reducing, at all, the dislocated femur, since it could not
be kept in place. Hegetor accused him of not understanding the anatomy
of the hip joint."

After stating that diseases were actively treated prior to the time of
Hippocrates, it is observed by Dr. Bartlett :

" It is true, then, that Hippocrates entered upon a field already alive and busy
with a certain degree and variety of scientific activity ; and that he found al-
ready accumulated, and more or less prepared to his hands, an aggregate by
no means small or unimportant, of authentic observation, recorded and tradi-
tional. Even Hippocrates had his past ; there was a medical history older
than himself.

The Persian kings, more than a hundred years before the time of Hippocra-
tes, were in the habit of employing Greek physicians, attached to their courts.

676

The New-Orleans Medical and Surgical Journal.

The singular history of Democides is a curious illustration of the condition and
the social position of physicians at that time. He was the first, says Grote, of
those many able Greek surgeons, who were seized, carried up to Susa, and there
detained for the great king, his court and harem.

In studying the character and position of Greek medicine at the time of Hip-
pocrates, and in estimating its scientific claims and pretensions, it is important
to notice how little of it came from abroad. The Greeks derived their earliest
notions of astronomy from the Chaldeans, but there is no evidence that medi-
cine had ever advanced beyond the lowest and rudest condition on the banks of
the Tigris and the Euphrates. We are told by Herodotus, that in the city of
Babylon the sick were brought to the market places, and exposed to the exami-
nations of the public, for such rude assistance as any chance comers might
offer.

By the Egyptian priesthood, it is true, medicine was more formally cultivated.
But although at the time of Hippocrates Egypt had been opened to Greece for
two hundred years, and although it is well known that many of the Greek his-
torians, poets and philosophers visited this elder seat of civilization, and studied
its character and institutions, it does not appear that Greek medicine was in-
debted in any considerable degree to that of Egypt. If Greece received any
thing from Egypt, it was like the wheat taken from her dark old sepulchres,
where it had lain dormant for ages, and which germinated and brought forth its
full-headed and golden sheaves only when planted in her own pregnant and
prolific soil. The character of the Egyptian mind, and of Egyptian institutions,
fixed, stationary, shackled, unexpansive, was adverse and unfriendly to the ori-
gin and development of any arts and sciences requiring independent and vari-
ous observation. On the contrary, the fact of which I am speaking, in regard
to Greek medicine, finds its natural and obvious solution in the character and
qualities of the Greek mind. This mind was wonderfully quick, susceptible,
apprehensive, and to a great extent it was free. Grote calls the Greek 'flexible,
many-sided and self-organizing.' 'The Iliad and the Odyssey,' he says, 'de-
monstrate, in the primitive Greeks, a mental organization, unparalleled in any
other people.' "

Many parts of the Discourse may be found enlarged upon in the
writings of Hippocrates and Galen, by John Redman Coxe, M. D.

The condensed statements of Dr. Bartlett may be read with pleasure
and profit. G. T. B.

X. — Sketches of Military Surgery. An Introductory Discourse deli-
ver d to the Kentucky School of Medicine. By Prof. J. B. Flint.
1852.

In this well written Lecture, we are carried back to the times of
Chiron, Podalerious, Machaon, and others of the heroic age — to the
times when the practice of Surgery elevated its followers among the

Reviews. — Report of the Charity Hospital of N. O. 677

gods, and conferred immortality upon those who performed the part of
Chirurgeons on the fields of battle in the plains of Troy — to the times
when ball and powder were unknown in the contest for power and do.
minion among- the nations of the earth — to the times when Homer eu-
logised the healing art, and sketched with a master's hand the achieve-
ments of his military Surgeons.

We shall not attempt even an outline of the graphic sketch of mar-
tial surgery, given by Prof. Flint in this lecture ; all who have read
the history of medicine must be familiar with the facts and events
which he has so well related in this discourse. But to the students to
whom it was addressed, and for whom it was prepared, it must have
been exceedingly interesting and instructive. A portion of the lecture
is devoted to the consideration of American Military Surgery during
the revolutionary war, when many of the most " eminent practitioners
of the day, at great sacrifice of personal ease and profit, devoted them-
selves to their country, in professional attentions to her patriotic
troops."

The first Surgeon-General in the American army was Benjamin
Church of Boston, who accepted this responsible office at the instance
of Gen. Washington. Some of the noblest spirits that engaged in that
immortal contest — that contest which secured us liberty, appertained to
the medical profession ; indeed the services rendered our heroic little
army and our country, by the Physicians of those days, are duly chron-
icled and embalmed in this truly eloquent lecture. Our author closes
with some severe strictures upon the present mode of appointing and
promoting Surgeons in the Army and Navy.

XI. — Report of the Board of Administrators of the Charity Hospital
for 1852. New Orleans.

We have received from Henry Bier, Esq., Treasurer of the Charity
Hospital, the annual Report of the Board of Administrators for 1852,
which is addressed to the Hon. Senate and House of Representatives of
the State of Louisiana.

Among many suggestions contained in this Report, to advance the
interests of that great charity, we notice particularly the following,
which we heartily endorse. The Report insists, as heretofore, " upon
the absolute necessity of establishing some institution, in the suburbs

678

The New-Orleans Medical and Surgical Journal.

of the city, combining the properties and advantages of an Alms House
and Hospital, for the reception and treatment of contagious diseases,
such as small-pox, ship fever, etc.— the care and entertainment of help*
less and incurable pauper invalids." The Board also further urge the
propriety of additional provision for the reception and treatment of the
insane.

The want of an Hospital or Lazaretto out of the city limits, for the
reception, seclusion and treatment of those afflicted with infectious,
contagious, or communicable diseases, is so great, and seemingly so ob-
vious, and has been so often urged, that we are not a little surprised
that it has been so long either overlooked or disregarded by those who
have the power to act in this important matter, hi defying contagious
and pestilential diseases, New Orleans assuredly stands far in advance
of any other large city of the Union—perhaps of the world. Our ex-
emption from plague, pestilence, etc., can only be ascribed to the mer-
cies of Providence ; for in sooth, every species of disease, from what-
ever quarter of the globe it may be brought, is freely admitted into our
gates without let or hindrance ; we have no sentinels, like other popu-
lous towns, to guard the portals of our hospitals ; the infectious subjects
are thrown, pell mell, with those laboring under simple and benign
types of diseases ; typhoid and typhus fevers, just imported from the
shores of Europe, being brought in juxtaposition with our simple inter-
mittent and remittent fevers, in the crowded wards of our Hospitals —
soon spreads from bed to bed, diffusing infection in every direction, and
ceasing only with the death of its hundred victims. Now, all medical
history and observation go to demonstrate, that separation or segrega-
tion is the surest and most certain method of checking and finally ex-
tinguishing the germs or poison by which typhus and typhoid fevers are
propagated from one subject to another. Let our authorities bear this
fact constantly in mind, and they will soon fall upon the only sure remedy
— the establishment of an Infectious Hospital out of the city limits, by
which this class of diseases may be held in check, if not utterly ban-
ished from our precincts. Our present exemption from all kinds of con-
tagious diseases is surely no guarantee for the future ; a single day
may suffice for the introduction of unnumbered ills — -of a host of zymo-
tic affections, which may require weeks to subdue, and months to ex-
terminate.

But why dwell at length on the necessity of providing other accom-
modations beyond the city limits for infectious diseases ? The evils
resulting from the unrestrained reception of this class of patients into
the Charity Hospital, have been again and again spread before the au-

Reviews. — Dr. Bond on Dental Midicine.

679

thorities, and still no steps have been taken— no movement made — no
remedy provided for the sick immigrant, other than this much abused,
but noble institution.

We leave this subject for the present, still hoping that some plan
may ultimately be devised, by which every species of contagious or in-
fectious disease shall be excluded from the Hospital.

The births for 1852 were 173. Males 86, females 76. Still-born
11. Total deaths during the year 2098.

The aggregate number of patients admitted for 1852 was 18,035
" " " discharged " 15,057

" " " died, " 2,098

Of the whole number of patients there were —

From foreign countries, 16,144
From the United States, 1709
Unknown, 181
Of which number only 248 were from the State of Louisiana !

We would not boast of being more charitable than our neighbors)
but would ask, in no spirit of self-laudation, what State in the Union, of
our population, extends similar aid and comfort to as many sick and
distressed strangers ? Nor must it be forgotten that these eighteen
thousand patients receive gratuitously the services of the Medical Fa-
culty ofthis city!

XII. — A Practical Treatise on Dental Medicine. With an inquiry
into the use of Chloroform, etc., etc. Second edition, revised and
enlarged. By Thos. E. Bond, A. M. M. D. 1852.

Without any special knowledge on the subject of Dentistry, and with
less taste for dental manipulations, we can nevertheless go so far as
to state, that the work by Dr. Bond forms an excellent guide for those
who are engaged in this branch of our profession. We observe, ne-
vertheless, that the author, in imitation of nearly all who take up and
treat of any speciality, would have the world to believe that "bad or de-
cayed teeth lay the foundation for nearly all the diseases and ills to
which poor human uature is exposed. This is in part true ; but it is
not wholly correct. In some subjects the least dental irritation excites
a serious train of morbid actions which may induce serious disturbance
of the entire organism ; whilst in other individuals, the entire teeth may
perish of caries, one after another, and yet be attended with little lo-

680

The New-Orleans Medical and Surgical Journal,

cal and less constitutional disturbance. It is affectation to magnify
trifles after this fashion; better state candidly the facts, and leave the
public to decide on their merits.

In the work before us the author has trenched considerably on the
domain of surgery proper, and so far, we conceive, has transcended
the limits to which the title of the work bound him. We believe Dr.
Hullihen's new method of plugging decayed teeth, after a lateral per-
foration of the body of the tooth, near its root, has been discovered and
made known since this work passed through the press. Doubtless ere
this reaches another edition, the operation will have been fully tested^
and if found to be all that is claimed for it, will be fully detailed by the
author.

The work is useful, and may be found at Steel's, 60 Camp street.

XIII. — On Variations of Pitch in Percussion and Respiratory Sounds,
and their application to Physical Diagnosis. A Prize Essay. By
Austin Flint, M. D., of Buffalo, New York. 1852.
The prize papers, elicited by the National Medical Association, begin
to awake some of the ambitious spirits in our profession ; and hence,
much good both to the profession and the public interest, may be, in
due time, expected from this source. The Essay before us, from the
pen of Dr. Flint, will serve as an excellent guide for those who may
strike for any prize that may be offered hereafter, being clearly stated
and candidly and philosophically argued in all its details. The applica-
tion of the principles embodied in the title of the paper, is, we believe^
quite new ; and it will be for the profession to determine how far Prof.
F. has made them subservient to the elucidation of disease. The Es-
say reached us too late to receive, in this number, that careful and ex-
tended analysis to which the writings of the Louis of America are en-
titled.

|p art loxxxtt).

MISCELLANEOUS MEDICAL INTELLIGENCE.

I. — Last illness of the late Hon. Daniel Webster, Secretary of State — with
a description of the post mortem appearances.

This number of the Journal contains a history, taken from a late London
Lancet, of the last illness of the " Iron Duke" the hero of Waterloo ; but we
have no account of the post mortem appearances of his Grace. It rarely falls
to the lot of an editor of a bi-mon/.hly to record the medical history of two such
remarkable men as the Hon. Daniel Webster and the famous Duke of Wel-
lington ; the first, a statesman of vast and comprehensive intellect, whose
claims to history and immortality were established in the Senate Chamber and
in the Forum ; the other, a warrior — a General, whose military exploits and
extraordinary achievements on the battle-field proclaimed him the first Captain
of his age.

But we have to deal now with frail mortality — with all that remains of the
great and the powerful. We may not inaptly apply the language of Horace to
these two characters :

Pallida mors ccquo pulsat pede pauperum labernas,
Regumque turres.

Infirmity and death must overtake all ; alike the mighty and the impotent, fall
before the great Destroyer.

Daniel Webster was of a sanguineo-bilious temperament, of a swarthy com-
plexion, with straight black hair, with a large, athletic and well proportioned
frame. He was five feet ten inches in height, and when in health weighed
190 pounds. His appearance was peculiarly imposing, and the expression of
his features, more particularly of his eye, was perhaps more powerful than that
of any other man. At his death he was nearly 71 years of age. Although
endowed with an iron constitution, Mr. Webster had been subject to an habitual
diarrhceafor the last eighteen nr twenty years. For about the same length of
time, he had also been a sufferer from catarrh, which seemed to give him much
trouble from about the middl^ of August up to the first of October of each
year.

082 The New-Orleans Medical and Surgical Journal.

In September, 1852, Mr. Webster on his return from Washington to Marsh-
field, took cold in Baltimore, and first complained of the symptoms connected
with his last illness. At this time his complexion, (never very clear) was sal-
low, though not jaundiced ; he had lost much flesh, and was quite feeble; com-
plained of pain, or rather uneasiness in the left side of the abdomen, with a
sense of tightness across the lower portion of the bowels. The bowels were
]oose ; appetite gone ; skin commonly dry ; also fauces and tongue, with much
thirst; pulse 106, full but compressible, and jerking, with 5 intermissions the
minute. Urine scant and high colored ; abdomen distended with flatus, with
some evidence of dropsical effusion. There was no tenderness over any part
of the abdomen ; the feet and legs were CEdematous. He complained of a
gouty pain in the feet, limbs, etc. He had about three dejections in the twenty-
four hours, the last of which was loose, urgent and attended with flatus. In
this state of the bowels, Mr. W. was ordered the following : (the italics are
ours, Ed.) " To take two drachms of castor oil, and an equal quantity of lemon juice^
every second or third day, if troubled by distension, or if the bowels did not act
Undly ,'•**

He was at the same time ordered a cardiac mixture twice a day, and a "pill
of one grain of acetous extract of colchicum with two grains of camphor each
night. At the same time friction and alcaline baths were used. On the 30th
his Physician again saw Mr. W. at Marshfield, with nearly the same symp-
toms ; the abdomen, however, was a little more tense and flat, with evident
fluctuation, and soreness on the left side ; for this five leeches were applied
with relief,"

At the above date, (30th) he was ordered one sixteenth of a grain of mor-
phine ; to have the abdomen fomented with spirits turpentine, and to take a
pill of four grains camph. extract of colocynth, and to have eight or ten leeches
applied to right hypochondrium ; and lastly, to take two tea spoonfuls of brandy
once daily.

Soon after the above date, Mr. Webster became sick at the stomach ; vom-
ited blood repeatedly ; began to sink, and expired a little after two o'clock Sun-
day morning, October 24th, 1852.

The Autopsy was made in the presence of his Physician, Dr. Jeffries, Drs.
Porter, J. W. Warren, Wyman, Parkman and Jackson. In the abdomen ele-
ven pints of serum was found. Adhesions existed about the spleen, gall blad-
der, ccecum and arch of the colon. The stomach contained half a pint of dark
blood ; its mucous membrane rather softened and mamellonated ; blood was
found in the primcc vice as far down as the descending colon. No ulceration
was detected in any part of the alimentary canal, to account for the chronic
diarrhoea. The liver was granulated, dense, and contracted in size ; its weight
was three pounds and one third avoirdnpoise ; bile in gall bladder nearly black
and tarry. Spleen small, pale and shrunken ; its peritoneal covering was
opaque and thickened. Kidneys and pelvic organs healthy. In the thorax^

Miscellaneous Medical Intelligence.

683

old pleuritic adhesions over nearly the entire right side ; on the left none. The
lower part of both lungs congested and dark ; passive. Heart flaccid and
nearly empty; slight disease of aortic valves ; otherwise organ healthy. Ab-
dominal aorta slightly ossified.

Head. — All the membranes of the brain remarkably diseased. The arach-
noid was greatly thickened by a layer of fibrine, and the " serous effusion into
the membranes was altogether large." The substance of the brain was
healthy.

The immediate cause of Mr. Webster's death was passive hemorrhage of
the stomach.

The capacity of Mr. Webster's cranium was 122 cubic inches; whereas
Dr. Morton's estimate of the average capacity of the Teutonic family (includ-
ing English, Germans and Anglo-Americans) is 92 cubic inches.

We condense the above from the report of Dr. Jeffries, published as already
stated, in the July number of the American Journal. We feel satisfied our
subscribers will peruse it with serious interest.

Remarks. — We have italicised that portion of the report upon which we
wish to make a few comments ; not with any disposition to " disagree" with
the very able men who managed the case, but as a text upon which to hang a
few observations.

Judging from the symptoms, as detailed, Mr. Webster suffered witb irritable
bowels, and yet he was ordered castor oil and lemon juice, either of which, we
have been taught, both by experience and theory, would aggravate the evil for
which they were prescribed. Lemon juice and castor oil for enteric irritation,
attended with "flatus, and loose, frequent, and urgent dejections /" We opine
Hamilton himself, had he stood at Mr. Webster's bed-side, would have paused
before venturing upon such a prescription. Not content with the mischief
that might have been produced (for the patient did grow worse) by castor oil
and an active vegetable acid, the illustrious patient was ordered, just on the
heels of this prescription, " cardiac mixture" and a "pill of one grain of acet-
ous extract of colchicum with two grains of camphor each night" Colchicum
and camphor to follow a dose of oil and lemon juice, in a case of irritable
bowels, with dry skin, tongue and fauces, and with a pulse 106 and jerking,"
seem to us in direct conflict with the pathology and therapeutics of the present
day. We should have preferred a small quantity of blue mass,"with extract
Hyosciamus, suspended in a large quantity of mucilage, as both more rational
and less likely to augment the gastro-enteric irritation. It is true, at a later
date the patient was allowed one sixteenth of a grain of morphine and two tea
spoonfuls of brandy per diem. If we have been correctly informed, Mr. Web.
ster had been a free eater, and drank wine freely at dinner (and this fact the
state of his liver clearly demonstrated) ; and yet he was allowed only two tea
spoonfuls of brandy, when perhaps a more liberal allowance might_have sus-
tained his sinking powers and exhausted system.

684 The New-Orleans Medical and Surgical Journal

It is stated that the Duke of Wellington was suffered to perish for want of
a glass of brandy and water ; and we can but think the life of our great states-
man might have been at least prolonged, had his attendants given him brandy
or wine more freely. These are, however, mere speculations post hoc, and are
not intended to reflect upon the motives or skill of the distinguished medical
gentlemen who waited upon the Secretary of State.

(Ed. N. O. Med. and Sur. Jour.)

II. — Potash in the treatment of Scurvy.

An Assistant Surgeon U. S. Army, Dr. Hammond, stationed in New Mex-
ico, reports in the January No. 1853, (American Journal Medical Sciences) se-
veral cases of scorbutic disease met with among the troops under his care, in
which he tried the potash with speedy and marked good effects. The cases,
although not numerous, were well marked by the usual loathsome symptoms,
all of which disappeared under the alcaline treatment.

Dr. Hammond gave the carbonate of potash in five grain doses (very small
— Ed.) three times daily, and in no case did the disease resist the remedy beyond
one or two weeks. The bitartrate of potash, he thinks preferable, and of this
he gave one drachm three times daily. Dr. Hammond tells us that he was
led to adopt this treatment upon the hypothesis thrown out by Dr. Garrod of
London : that scurvy depends for its existence upon a deficiency of potash in
the blood, which potash is essential to the nutrition of muscular fibre.

(Ed. N. O. Med. Journal)

lll.-On the Function of the Spleen and other Lymphatic Glands as Secretors of the

Blood.

BY DR. J. H. BENNETT.

Dr. Hughes Bennett here treats of, 1st, the relation between the colorless and col-
ored corpuscles of the blood ; 2d, the origin of blood corpuscles ; 3d, their ultimate
destination.

1. Relations between the Colorless and Colored Corpuscles. Dr. Bennett believes
with Mr. Wharton Jones, that the colored corpuscle is merely the liberated nucleus
of the colorless cell ; the transformation takes place in the following manner : The
colorless cell may frequently be seen by the aid of acetic acid, to have a single round
nucleus ; but more commonly the nucleus is divided, each half having a distinct
depression, with a shadowed spot on the centre. Occasionally, before division takes
place, the nucleus becomes oval, elongated, and somewhat bent, or of a horse shoe
form. It may be divided into three or four granules ; these stages are figured by Dr.
Bennett ; they were discovered by him in his interesting observations on leucocythe-
mia, and in experiments on mammals, birds, reptiles and fishes.

He does not believe with Mr. Wharton Jones, that all the nuclei forming the col-

Miscellaneous Medical Intelligence.

685

ored corpuscles in mammals should necessarily be provided with a cell wall. Many
however, do proceed beyond this point, and may be seen to have cell walls ; the nu-
clei in such cases increase endogenously, by fissiparous division, and on the solution
of the cell wall, become colored blood discs. In fishes, reptiles and birds, the colored
blood-corpuscles are nucleated cells, originating in blood glands.

2. Origin of the Blood Corpuscles. This, as was enunciated many years ago by
Hewson, is to be looked for in the lymphatic glandular system, under which head are
included the spleen, thymus, thyroid, supra-renal, pineal and lymphatic glands.
Nuclei and nucleated cells are found in these bodies, and Dr. Bennett's observations
on leucocythema have shown that an increase of colorless cells in the blood is con-
nected with enlargement of the spleen and other glandular organs. The blood of the
splenic and portal veins is always richer in colorless corpuscles than that of the syste-
mic circulation ; and in young animals, in which the thyroid, thymus and supra-
renal glands are most fully developed, the blood contains most colorless corpuscles.
Moreover, in case of enlargement of the thyroid body, this organ contained cells and
nuclei of much smaller cells than usual, and corresponding cells and nuclei were
found in the blood. In another case, the colorless corpuscles in the blood were of
two distinct sizes, corresponding with a similar appearance in the corpuscles of the
lymphatic glands. It is difficult to determine how the corpuscles find their way from
the lymphatic glands into the blood ; but Dr. Bennett suspects that there must be a
direct venous communication. He believes that if he has established that the corpus-
cular elements in the so-called blood glands are transformed into those of the blood,
"it will follow that the lymphatic glands secrete the blood-corpuscles in the same
manner as the testes secrete the spermatozoa, the mammae the globules of the milk,
or the salivary and gastric glands secrete the cells of the saliva and the gastric
juice.

The most probable and consistent mode of origin of the corpuscles is in an orga-
nic fluid, by the production of molecules, the successive development and aggregation
of which constitute the higher formations. Multitudes of free nuclei join the blood
and are at once converted into colored blood-discs ; and their cells circulate for a
time, when their walls are dissolved, and their nuclei become colored. The number
of colored corpuscles in the blood increases in proportion to the development of the
lymphatic glandular system in the animal kingdom, and Mr. Drummond and Dr.
Bennett have observe i that the nuclei in the spleen, varying in size in different ani-
mals, correspond with the nuclei of the blood-corpuscles.

Ultimate Destination of the Blood Corpuscles. Dr. Bennett believes that the
blood corpuscles are dissolved, and with the effete matter absorbed from the tissues
around the lymphatics, constitute blood-fibrin. Zimmerman believed that fibrin re-
sulted from the metamorphosis of the textures. The arguments which support this
view appear to Dr. Bennett to be unanswerable : there is no fibrin in the chyme,
very little in the chyle, less in carnivora than in herbivora ; there is no fibrin in the
egg, nor in the blood of the foetus, and very little in the new-born infant. On the
other hand, all those circumstances which cause exhaustion of the textures, or in-
crease the amount of absorption, augment the quality of the fibrin ; as after inflam-
matory or other exudations, starvation, violent fatigue, pregnancy, and frequent
bleeding and hemorrhage ; the amount of fibrin in the blood seems out of propor-
tion to what would be required for textural nutrition. Increase of fibrin is also ac-
companied with diminution of the red corpuscles ; hence it appears probable that
fibrin results from a solution of the blood corpuscles, conjoined with the effete matter
derived from the secondary digestion of the tissues, which is not converted into albu-
men.

(London Jour. Medicine.)

686 The New*Orieans Medical and Surgical Jnornah

IV '.^Medical Life in London.

We have had occasion heretofore to allude to the habit which has prevailed of late
years in this country, among writers in raed cal journals, and speakers at medical
gatherings, of disparaging the moral and educational standing of American practi-
tioners. It is said that the ranks of the profession are filled by persons poorly edu-
cated ; our medical schools are spoken of with contempt ; the tendency to quackery
both within and without the profession, is a constant theme of querulous complaint.
In all these particulars a comparison with other countries, of American medicine, is
frequently drawn, in which the latter is made to appear greatly inferior. Such a
habit of self-depreciation has become so confirmed, that whatever may be the pro-
gress made on this side of the Atlantic; many, it is to be feared, under the influence
of ideas that have been so much reiterated, will never have courage enough to feel,
a national pride in whatever may be accomplished. A disposition to undervalue, in
anticipation, any discovery or improvement originated in this country, is often appa-
rent. An extract from a foreign journal, containing something new proposed by
some one wholly unknown at this distance, not unfrequently passes current, or at-
tracts attention ; while a novelty, from a responsible source, which labors under the
disadvantage of being a home production, may not only be overlooked, but, as it
would seem, studiously kept out of sight. For example, a practitioner of long expe-
rience and high standing announces a new method of reducing dislocations of the
hip joint, without the aid of pulleys, etc. He adduces several cases in which the
plan has been successfully tried. It excites some attention, but chiefly by those who
are anxious to prove that the author borrowed the idea from some one else. By:
some journalists and surgical teachers the subject meets with no notice whatever^
they are not willing even to make trial of the plan, and considerable effort is neces-
sary to bring it sufficiently before the profession to secure a sufficient number of cases
for a fair experimental test of its merits. Even the great discovery of the employ-
ment of anaesthetic agents in surgery has met with an active opposition at home
which it has not had to encounter abroad.

With the low estimation of American medicine, which appears to be cherished
to a considerable extent among ourselves, it may contribute somewhat to a higher
grade of self-respect to read what the profession of other countries say, not of us, but
of themselves. With this view We quote a few paragraphs from a series of articles
which have lately appeared in the Dublin Medical Press, headed, " Medical Life in
London. ' Speaking of medical students, the writer says :

" We said enough before perhaps as to the very insufficient education that medical
students receive before they join the classes ; it is not difficult now to perceive how
likely they are to be misguided as to the true and noble calling in which they have
embarked, by the ridiculous books and essays which fall in their way ; the pro-
duct of the overgrown trade in these commodities. Accordingly, one meets them
constantly at Guy's, at King's and Bartholomew's, arguing, even with the chief
men there, as to their convictions on mesmerism, the marvellous cures they had
read by homoeopathy. The trite creed of too many of these young men, that all
physic is humbug — their knowledge of physic no doubt being very nonsensical — is
due to the utterly absurd books they had been reading, the result of this frightful
trading principle of the book trade, and the favoritism shown to special authors who
happen to have money. * * * * In London the student sees the uneducated
chemist and the College of Surgeons the only people making fortunes. He votes
physic a bore ; the College of Physicians, like the Court of Chancery, a great pro-
fessional incubus to be avoided ; advancement in professional life as impossible as the
discovery on his own private account of perpetual motion. He knows half the mo-
ney he has lost would get him a commission in the army, or set him up in a cotton
mill. He has heard of Apothecaries' Hall ; but on looking into the books, he thinks
he might as well try to learn Dutch and Sanscrit, as Dr. Lindley's big words ; he
never does learn them, for he never learned Greek or Latin ; he has been reading
novels and the books about Egypt, and the salt cellars, or the latest rubbish sent
with the author's compliments to his hospital library ; three years, four and some-
times five, he spends in this mortifying way. In October he comes up, like all his
fellow geese, poor fellow, to be plucked and to hear the introductory lectures, at
which he is told his profession is all pleasantness and all its paths peace ; that he

Miscellaneous Medical Intelligence.

687

has only to follow the directions of each particular lecturer to make a solid fortune
and gain a commanding corner in the temple of fame. If now he runs away
without diploma or certificate and sets up a chemist's shop, he is safe ; if he waits
for academic honors and the College of Surgeon's soirees, he will rue it all the
days of his life. Godfrey's cordial and chemicals carry the day ; or if the trade
in horaoeopathicals promises better, he has no scruples ; for long since he has de-
cided physic all humbug. Even Dr. Pereira, who is considered a Jew, and who,
one would think, should make money, if anybody did, out of medicine, is of opinion
all English physic is nonsensical."

Of the profession he adds :

" We have just had a meeting of the Provincial Medical Association at Oxford ;
but with such a disjointed and dissociated mass as the profession in London, one
looks in vain for any thing very enlivening at these gatherings. If one could
read the signs of the times, or in any point of the professional zodiac, of a complete
sweeping away of all present overgrown abuses, then might one indeed breathe freely
the open air of heaven. Like the reform in its next door neighbor, Chancery, brought
about by the pen of honest, thoughtful men like Dickens, perhaps other parts of
Lincolu's-inn-fields will yet undergo some change for the better ; and when the pepper
boxes of the National Gallery at the West-end of London, the not very oderous
or captivating abuses of the College of Physicians also next door, and two or three
quack hospitals, are also removed, we may yet sing psens of thanksgivings to what
Mr. D'Israeli calls the spirit of the age. A member of the College of Physicians,
may be sent to Newgate if he perpetrates the crime of consulting with the president
or any member of any Dublin or Edinburg College of Physicians, or any other M.
D. " whatsomnever ;" but they have been known to send nice three cornered notes,
appointing hours to meet fashionable homoeopathists. At the soirees, also, one sees
emblazoned in all the papers, the sorriest kind of tuft-hunting is had recourse to, and
strangers of Rome, " Cretes and Arabians," any body and every body, but exactly
those for whom one would think royal colleges, medical and chirurgical, were erected,
are invited ; the pleasant ultimate result of all such corporate bodies here, being, that
all struggling medical men might as well have a millstone around their necks as the
excruciatingly absurd care and patronage of these big buildings. With money, of
course, young medical men in London will make a fortune. A slender apprenticeship
to quackery, however, is as indispensable as kid gloves at the College of Physicians'
tea parties. * * * If a man wishes to be happy and contented, and live among
his patients, he will sedulously avoid all and each of these. If he is a quack, it is
painful to repeat again, he is sure of a fortune. If he is honest, the millstone of the
journals and colleges will be his destruction."

Again :

" The practice of physic and surgery in the hospitals is unexceptionable. The
moral influence of the colleges and press out of doors, the most melancholy sham *
quackery and trade existing in every department of the profession ; but perhaps the'
lowest and the highest in the court and highest circles, and in the daily drudgery of
the lowest or union practice among the poor, the experience of every disinterested man
is against quackery."

We cannot, of course, vouch for the correctness of the representation of medical
life in London, as given in the above quotations. With respect to this point, it is not
to be forgotten that London and Dublin are different places, although situated in
Great Britain. How much of the spirit of the articles referred to is due to rivalry of
location, we cannot presume to say. We have given the quotations, in order that those
of our readers who would be glad to think better of medical life in their own country,
than they who appear to have a fondness for disparaging it, may be encouraged by
the fact, that in the great English metropolis, a writer on the spot finds as much
scope for animadversion and ridicule, as the warmest advocate for American inferi-
ority could claim in behalf of the medical profession on this side of the Atlantic.

{Buffalo Med. Jour.)

688

The New Orleans Medical and Surgical Journal.

V — DEATHS IN THE CITY OF PHILADELPHIA.

The following table exhibits the total number of deaths for 1852 in the city

of Philadelphia.

1. Endemic and Contagious Diseases
Zymotic or Epidemic,

2. Uncertain or general seat,
Sporadic diseases,

4. The Nervous System .

5. Organs of Respiration,

6. " Circulation,

7. Digestive Organs,
8 UrinaryOrgans,

Generative Organs,

10. Locomotive Organs,

11. Integumentary System,

12. Old Age,

13. External Causes,
Still Born,
Unknown,

Total deaths for 1852,

[Med. Exam.]

Male.

Female

Total.

1398

1837

2785

698

575

1273

957

712

1669

1147

1025

2172

lid

105

91 Q

313

314

627

104

112

135

192

240

322

293

323

516

149

126

275

5437

4821

10258

VI Deaths in the city of Baltimore, (Md.)from January 1852 to January 1853.

We are under obligations to Dr. J. Gilman for a copy of the Annual Report of the
Commissioner of Health of the city of Baltimore, from which we glean the follow-
ing:

Total deaths from all diseases for the year 1852, in the city of Baltimore, 5313 ; of
which 348 were still-born ; 339 died of cholera infantum ; 728 of consumption ; 551
of fevers ; 314 of measles ; 64 of small-pox ; 174 of old age; and the balance of
the usual diseases.

The deaths for each month were as follows : January 351 ; February 396 ; March
509 ; April 434 ; May 458 ; June 287 ; July 488 ; August 702 ; September 409 ;
October 351; November 458; December 372. Total 5313. Not a single death by
cholera is recorded.

Miscellaneous Medical Intelligence.

689

VII. — Essential Oil of Savine as an Emenagogue.

Administered in the form of an injection by the rectum, Dr. Plagge asserts
that the essential oil of savine acts as a certain, safe and powerful emenagogue.
Eight or ten drops of the oil suspended in a three or four ounce fluid mixture,
given per anum, rarely fail to re-establish the menstrual flux, where its sup-
pression is not the effect of some organic disease of the uterus. (Ibid*)

VIII. — Aconite a remedy for Acute Articular Rheumatism.

A distinguished physician of the Hotel Dieu, France, recommends the alco-
holic extract of aconite as a specific remedy for acute articular rheumatism.
Given in the commencement of the attack, before the use of any other medi-
cine, it cures the disease in five or six days, says this physician. Of the alco-
holic extract, he gives it in the form of pills of 5 centigrammes each, and ad-
ministers one, two or three per diem, as the case may seem to require. In the
meantime, warm tea of elder flowers, and the like, are drank freely ; this deter-
mines a profuse perspiration, which speedily mitigates the violent symptoms.

(Ibid.)

IX. — Case of Dislocation of the Eye.

BY DR. JAMESON.

Dr. Jameson, in a late discourse before the Surgical Society of Ireland, de-
tailed the circumstances attending a dislocation of the eye, which had come
under his observation in Mercer's Hospital, Dublin, of which institution he is
Surgeon.

Peter Nowlan, aged 30, a powerfully able and muscular man, a corn porter'
was admitted into Mercer's Hospital on the 3d of November last, at half past
twelve o'clock at night. His wife informed me that he came home that even-
ing at ten o'clock, in a most intoxicated condition, and while staggering about
his room, he struck his right eye against a small iron hook or nail that was in
a dresser, which entered at the outer angle of the upper eyelid of that side, and
when she went to his assistance discovered his eye protruded from its socket.
She was most anxious to remove him at once to the hospital, but could not suc-
ceed in prevailing on him to go until half past twelve at night, when in a few
minutes after this I saw him.

He was very boisterous and unruly, had a large check apron held close up
to his eye, which he kept constantly rubbing and pressing against it. On its
being removed, he presented a most peculiar, and I might add, frightful appear-
ance. There was the right eye protruded out of the orbit, firmly fixed and
immovable, staring, elastic to the touch, and devoid of all power of vision. The
cornea was dry. cloudy, and rather opaque, pupil moderately contracted, and
uninfluenced by the light of a candle. There was no extravasation of blood,
nor was there any vascularity of the conjunctiva, although its reflexion from the
upper lid on the globe of the eye was partially torn through. The inferior
margin of the upper lid was not visible, as it was placed behind the globe and
spasmodically closed.

690

The New-Orleans Medical and Surgical Journal.

With difficulty I could get him restrained, as he was such a powerful man,
but having accomplished it, I then, with two fingers of my left hand, elevated
the upper lid, at the same time, with the finger and thumb of my right, pressed
the ball of the eye, and immediately it was drawn back with a distinct snap,
and the lids closed over its anterior surface. I now, for the first time, observed
the small wound before alluded to, at the outer angle of the upper lid, but could
not ascertain or form any conjecture at the time what amount of injury he
might otherwise have sustained. I therefore had him conveyed to bed, and
directed cold water to be assiduously applied to the part for the remainder of
the night.

4th. The following morning, at visiting hour, we found him sober, but he did
not recollect much of what had occurred. His eyelids were a little swollen ;
there was some slight vascularity of the conjunctiva; the cornea was clear,
shining, and moist, and the tears ran down the cheek ; he could distinguish the
day light ; complained of pain in the head, and a deep pain in the globe of the
eye, with full pulse. He was ordered to have sixteen ounces of blood taken
from his arm, bowels to be freely opened, and cold water to be continued to the
part.

5th. Lids less tumid ; pain and vascularity of conjunctiva almost gone ;
complains of the sensation as if gravel were between the Jids ; vision improved,
but sees objects imperfectly, as through a thick haze. Ordered the tart. ant.
mist., low diet, and the application of cold water to be continued to the
part.

6th. All pain gone ; conjunctival vascularity less ; sensation as if gravel
were beneath the lids gone ; vision nearly restored ; has completer power over
all the motions of the eye. Continue all.

7th. Convalescent; no suffusion ; no pain ; vision complete-

9th. Discharged cured.

The foregoing case I consider to be one of some interest, when we reflect on
the novelty and nature of the accident, and the mode of its being inflicted. In
the first instance, the great escape the orbital plate of the frontal bone had of
being pierced, and consequent injury to the anterior lobe of the brain. Again,
the length of time the cornea was left uncovered by the palpebral, being two
hours and a half, and all that time coarsely rubbed by the apron. The great
state of tension the optic nerve must have been kept in without permanent loss
of vison. The escape the muscular attachments had of being torn from their
origins, which evidently must have been the case from the subsequent perfect
control retained over all the motions of the eye, as soon as the very slight
amount of inflammation produced by the accident was removed. The power-
ful contraction of the orbicularis muscle behind the globe, with the complete
restoration of vision. And finally, the trifling amount of constitutional distur-
bance and local inflammation that followed what appeared to be at first so very
grave an accident to so very delicate an organ. These, I say, are points which
add considerably to the interest of the case.

{Dublin Med. Press.)

X. — Iodine Injections of the Joints,

BY M. VELPEATJ.

Amongst the affections of the joints, effusion into them is a very common
affection, but is only serious as a symptom of the disease which accompanies
it. When it occurs as a serous interarticular effusion, without any marked
material lesion, recent hydrops articuli is easily cured by rest, bleeding and top-
ical applications, such as solutions containing muriate of ammonia or chloride
of sodium. When the effusion resists these means, M. Velpeau applies a large

Miscellaneous Medical Intelligence.

691

fly blister, repeated every fifteen days, and then uses frictions, with mercurial
or iodide of lead ointment (the latter being preferable to the iodide of potash),
aided by compression, the administration of calomel in small doses, and especi-
ally rest.

There is another remedy now used, namely, the injection of tincture of iodine.
M. Velpeau has only tried it twice this year, but from these two cases it is
plain that the injection thus used is neither very painful nor dangerous, and
that when thus cured the joint is not anchylosed. In one very bad case, parti-
cularly, the injection was not more painful than when used for the cure of hy-
drocele, and succeeded where the other means referred to had failed. It is
necessary that the treatment by iodine injection should be made more gener-
ally known, as it is not usually practised. The two points which deter surgeons
from practising it are, the fear of throwing an irritating fluid into a large joint,
and of anchylosis taking place in case of success.

Now, both of these dangers are imaginary. There is no previous incision,
but a simple puncture made. Since 1839, M. Velpeau has used this plan 25
times, M. Bonnet perhaps as often , so that with cases of the same kind, related
by Berard, and since by M. Jobert, Malgaigne, and other surgeons, there are
more than one hundred cases of these joints having been punctured and treated
by the iodine injection, and none of the patients have had any unfavorable
symptom. The swelling, with slight redness, which appears after the opera-
tion, only shows that a natural process is going on, such as takes place in hy-
drocele, and is resolved without the application of leeches, etc.

As to the danger of anchylosis, it is equally imaginary. M. Velpeau has
seen these patients long after the operation, and in all the movements of the
joints were preserved. It is in fact in these cases, as in hydrocele, the cure can
be effected without the obliteration of the serous sac ; or, if adhesions take
place, they yield after a time, and the function of the joint is restored, so that
this is no serious objection ; and, as on the other hand, there is complete cure
in one half the cases, and very marked amelioration in the other, it is to be
concluded that the iodine injection, under such circumstances, when as yet
there is no induration, is suitable, and the more so, as its use does not pre-
vent that of other accessory means of cure.

(Presse Medicate de Beige.)

XI. — Causes of Yellow Fever.

In the January number of the Charleston Medical Review, Dr. Hume of that
city has prepared an elaborate article on the causes of yellow fever, abounding
in meteorological and statistical tables, which are quite interesting. Like sim-
ilar efforts made in this city, on the same subject, they only prove that " cool
nights, warm days, and a high dew point, are the meteorological characteristics
of a yellow fever summer in Charleston. Warm nights, warm or cool days,
and a low dew point, are the concomitants of a non-yellow fever summe^'

Well be these things thus ! Can we warm the atmosphere by night, or
cool it by day ? Can we lower the dew point, and by this means stay the irrup-
tion of an epidemic ? No. The combination of phenomena which produces
the yellow fever, is utterly beyond the control of mortal man.

692

The New- Orleans Medical and Surgical Journal.

XII. — M. Bouchardat on the treatment of Diabetes.
As long as the urine exhibits sugar, all feculant and saccharine aliments
must be strictly interdicted ; the flesh of carnivorous (! ) animals, M. Bouchar"
dat declares, is the best. This diet has been resorted to by the poor, afflicted
with the disease, and with immediate and marked improvement. Fish, with
oil and vinegar, may be allowed to both rich and poor, with advantage. Eggs
and cheese constitute an excellent diet in diabetes ; and green vegetables and
salads may be eaten in moderate quantities. Fatty substances and alcoholic
drinks should hold a high place in the diet of the diabetics. Beer is objection-
able, because it contains dextrine; but coffee, without milk or sugar, and to
which a little brandy is added, is an excellent drink ; but all acid drinks are
extremely hurtful. In the meantime, flannel should be worn next to the skin ;
and gentle exercise in the open air hastens recovery. As a medicine, M. B.
prefers the carbonate of ammonia, aided occasionally with some diaphoretic,
such as Dover powder, and the like. ( Abridged by Ed. N. O. Med. and Surg-
Jour, from Jan. No. 1853 of Med. Chirurg. Revieiv.)

XIII. — On the Specific Gravity of the Brain.
In an elaborate article on this subject, published in the January number of
the British and Foreign Medico-Chirurgical Review, and written by Dr.Sankey,
we copy the analysis of 77 observations made upon the specific gravity of the
brain, which would serve to justify the following general observations : That
the mean specific gravity of the grey matter, in either sex, is 1.034; that the
density of the grey matter is somewhat below the mean in the earlier and
later periods of life ; that the highest density is met with between the ages of
fifteen and 30 years in males, and between twenty and thirty years in females;
that the density of the grey matter is, in a slight degree, lower in those persons
who have died after a long illness, and greater, to a slight extent, in those
subjects examined before twelve hours after death than in those examined at
later periods. That the density of the grey matter may be found in a subject
after death to be .006 below the mean, without any cerebral symptoms having
been present during life ; but when the specific gravity exceeds the mean by
.006, then one of the following conditions has existed during life, viz : Either
acute cerebral disease, attended with head sympathies of the gravest character,
or chronic disease, attended either with no cerebral symptoms, or only with
slight delirium.

That the mean specific gravity of the white matter after death is 1.041 ; that
its density varies less than that of the grey in the sexes, or in the different
periods of life ; that it is much less affected by post mortem changes or length
of the last illness. That in those cases in which the gravest cerebral symp-
toms were present during life, the density of the white matter after death may
present two opposite conditions ; either it may exceed the average, or it may
be much below the mean.

That high specific gravity of both grey and white matter is found in con"

Miscellaneous Medical Intelligence,

693

junction with those morbid conditions of the brain connected with the hypere-
mia, and that a low specific gravity exists in conjunction with the opposite con-
dition of the brain.

That no relation appears to exist between the specific gravity and the
actual weight of the brain.

XIV. — Iodide of Potassium a remedy for the affections caused by lead and

mercury.

We find in the January number of the London edition of the British and Fo-
reign Medico-Chirurgical Review, a very valuable paper under the above head,
first published by M. Melsens, in the Annates de Chimie et de Physique. By
a series of experiments on man and dogs, conducted with great care, with the
results accurately noted, M. Melsens has conclusively shown, that the iodide
of potassium is not only a safe, certain and radical cure for the common forms
of saturnine and mercurial poisoning, but an equally sure preventive of the
injurious effects so frequently produced by emanations from lead and mercury.
M. M. assumes, that in all cases of lead and mercurial poisoning, the metallic
substance is in actual union with the affected part or parts, and is there retained
in the form of some insoluble compound. He believes that in these instances
the iodide of potassium, after it reaches the circulation, combines with the me-
tallic poison, and forms with it a new and soluble salt ; liberates the poison
from its union with the part or parts, dissolves it, and thus suffers it to again
enter the circulation. Once in the circulating fluids, (in the form of a double
iodide of mercury and potassium) M. Melsens supposes these metals to be eli-
minated from the blood and tissues through the kidneys, nearly as soon as
formed, in combination with any excess of the iodide that may chance to be
present.

M. Melsens details a number of cases of mercurial poisoning, in which the
iodide produced a rapid and permanent cure ; and in some instances, the elimi-
nation of the mercury by the kidneys was positively ascertained by reagents.
Most of us have had evidences of the anti-mercurial influence of the iodide of
potassium upon the human subject ; we have seen persons who had been the
victims of mercurial poisoning, after taking the potash a short time, become
profusely salivated. Does not this fact demonstrate that the potash liberates
the mercury from the tissues, throws it into the circulation, and leaves it free to
act on the glandular system ?

M. Melsens has proven, by repeated experiment, that if to a dog that has been
for some time under the poisonous influence of sulphate of lead, iodide of po-
tassium be administered suddenly in pretty large doses, death will ensue. If
on the contrary, the two drugs be given concurrently, the dog will suffer no
harm. Iodide of potassium may therefore be employed as a prophylactic in
lead-poisoning.

( Condensed by Ed. N. O. Med. and Surg. Jour.)

694 The New-Orleans Medical and Surgical Journal*

REPORT OF THE UNITED STATES MARINE HOSPITAL;

For the year ending December 31s?, 1852.
p. b. m'kelvev, Principal Physician and Surgeon.

Diseases, discKd of, in

January.

February

March

April

May

June

July

August

Septbr.

October

Novbr.

Decbr.

Total

Abscess

[

Amaurosis

Anchylosis

Ascites

Anemia

Bronchitis

Burns

Coup de Soleil

Contusions

Chilblains

Cataract

Carbuncle

Condylomata

Colic, Bilious

Colic, Pictonum

Cholera, Asphyxia

Caries, Sub. Max.
Constipation

Catarrh, Pulmon.

Diarrhoea,

119

Dysentery

Debility, General

Delirium Tremens

Dislocation, Wrist

do. Radius

Dyspepsia

Erysipelas

Fever, Intermittent

434

do. Remittent

do. Typhoid

100

do. Yellow

do. Congestive

Fracture of Rib

do Clavicle

do Tibia

Fistula in Ano

Gonorrhoea

Gastrodynia

Gastro Enter.

Hernia

Hydrocele

Hepatis, chronic
Hypertrophy of Spleen

4
11

Injuries

Iritis

Intemperance

Icterus

Lumbago

Neuralgia

Miscellaneous Medical intelligence.

695

Diseases, disch'd of, in

January.

February

March

April

May

June

July

' August

Septbr.

October

Novbr.

Decbr.

Total

Neurosis

Orchitis

! 1

i 2

Opthalmia

: 2

Paralysis, Partial

Phthisis Pulmonalis

Pneumonia

Paronchia

Pleuritis

Ptyalisra

Rheumatism

189

Rubeola

Syphilis

266

fepine, Injuries of

Scald

Stricture, Urethra

fecroiula

SrliirrJine: T'pct

^ 1111 1 11 UOj lust

Tumor

Ulcers

▼ (XllUla. UUllllU.C'Ils

do. Punct.

120

130

151

110

111

151

134

139

174

186

177

175

1758

Died of, in

Abscess oi Laver

Ascites

Brain, Congestion of

Cholera Asphyxia

Dysentery, chronic

Diarrhoea

Epilepsy

Erysipelas

Fever, Typhoid

do. Yellow

do Congestive

Gastro Duod.

Hydrothorax

Heart, disease of

Hepatis, chronic

Phthisis Pulmonalis

rnpnmnnin TNrrkli
x lie uiinjlllclj X V Mil,

Peritonitis

Injuries

Injuries of Spine

Suicide

Syphilis

Tetanus, traumatic

107

696 The New -Orleans Medical and Surgical Journal.

RECAPITULATION.

Remaining in the Hospital January 1st, 1852,

Admitted. Discharged. Died.

First quarter, 409 401 13

Second quarter, 398 372 23

Third quarter, 467 447 16

Fourth quarter, 592 538 52

Total, 1866 1758 104

Remaining Jan. 1st, 1852, 99 104

1862

103 remaining Jan. 1st, 1853.

J. W. BREEDLOVE, Phys., &c

XVI. — On the treatment of Mental Alienation.

In some observations on the treatment of Mental Alienation, M. Ph. Pinel
states that a large number of medical men recognize the utility of baths and
the necessity of prolonging their influence, especially in cases of mania, but
that at present they are prolonged for only a few hours. M. P. recommends
that the patient should be confined in a bath, of a suitable temperature, from
one to twenty-four hours, with gentle irrigations directed upon the head all
the while, with occasional interruptions. Baths, he remarks, of that duration,
the temperature of which may be too high 0 too low, are rather hurtful than
useful in these cases.

Baths frequently repeated, without effusions or constant sprinklings, increase
rather than diminish the cerebral symptoms. Prolonged tepid baths and sprink-
lings are, beyond a doubt, the best means that can be resorted to in the treat-
ment of the acute forms of insanity, not only in mania, but likewise in the dif-
ferent species of partial delirium. He states that he has treated in this man-
ner 157 patients, classed as follows :

Maniacal delirium 57; hyperamia 38; delirium without melancholia 20;
suicidal delirium 24 ; delirium tremens 16; erotomania 5 ; total 157, of whom
91 were males, and 66 females.

The following results have been recorded : No change 4 ; deaths 7 ; im-
provement 21 ; under treatment 4 ; cured i25. Of the 127 patients who were
thus treated, 125, or four fifths, were cured.

Editorial — City Intelligence, 69?

Vol. IX.] NEW-ORLEANS, MARCH 1, 1853. [No. 5.

HEALTH, MORTALITY, &c.

The past winter has been, we believe, unusually dry for this climate, although
we had our usual sudden atmospheric changes. We cannot recall a single
corresponding season during which we have seen and heard of less serious
sickness ; indeed, with the exception of slight catarrhal affections, to which
we alluded in our January number, we have had less winter disease than usual
in our city. Of the exanthema, we have had less than at any season within
our recollection ; true, we have met with a sporadic case of variola, rubeola
and scarlatina, but in these instances the disease confined itself to a few isolated
localities, or widely-separated families, or was introduced into the city from
abroad. In no instance have they been propagated much beyond the individu-
als whom the disease first invaded. The attention now paid to vaccination,
thanks to the immortal Jenner, has, in a great measure, placed small-pox hors
de combat, and effectually checked the spread of this loathsome disease. We
will embrace this occasion to urge upon those who may have received the pro-
tecting power of vaccination at some antecedent period, the absolute necessity
of being re-vaccinated once at least every few years, more particularly if likely
to be exposed to the contagion. Writers who have examined the question of
re-vaccination, urge this precautionary measure in every instance.

Typhoid, or continued fever, as it has been recently designated, and now
exciting so much interest in the South, has been less prevalent, we believe,
than usual, both in private and hospital practice, the past winter ; in fact, it has
been witnessed more as a complication of other diseases, than a primary affec-
tion. The cases thus far have been, in most instances, benign and manageable,
under a plan of treatment partly expectant and partly abortive. We have seen
a few cases, complicated with pneumonia, which terminated in profuse hemorr-
hage and death ; in one instance, the patient was about to enter the stage of
convalescence, when he was seized with nasal hemorrhage, and sank in a few
hours, in spite of stimulants, styptics, etc. This case had been for several
days partially under the influence of mercury, and hence perhaps the tendency
to the bloody exudations.

Scarlatina has prevailed to some extent in certain sections of the city ; still
the mortality from this disease has not been great, according to our weekly
returns.

Measles, although somewhat common, yet it has been of a very mild form,
seldom requiring the services of a Physician.

We have noticed that among the causes of deaths, Phthisis is the highest
on the list. This fact arises from the great numher of individuals, laboring
under this disease, who visit our city in the winter season in search of a more
uniform climate, and succumb here to the ravages of the disease. In asserting
this fact, we do not wish to be understood as denying the development of phthisis

698

The New-Orleans Medical and Surgical Journal.

among our resident, permanent population ; we have witnessed it in the native
born Louisianian, whether of Anglo-American, French, Spanish or German
parentage. It is not infrequent among our slave population ; and those of
mixed blood, mulattoes, etc., are peculiarly liable to pulmonary diseases in this
climate. Of this fact we could advance abundant evidence ; and we refer to
our bills of mortality to bear us out in the assertion.
We here append our weekly mortality since our January publication.

DEATHS IN THE CITY OF NEW ORLEANS,
For the 9 weeks ending Feb. 19$, 1853.

Cholera.

Fevers.

Total

1852

Dec. 25th

155

1853

Jan. 1st,

[Y. Fev. 2]

148

«« 8th,

148

a 15th,

136

" 22d,

134

" 29th,

110

Feb. 5th

[Y.Fev. 1]

« 12th,

118

M 19th,

130

Total,

164

1218

Of the foregoing 460 were under 10 years of age, and 248 were colored.

Compare the deaths for the nine weeks ending December 18, 1852, published
jn the January number, with the deaths for the same period, ending February
19th, 1853, and we have for the former 247 deaths by cholera, against 69 ; and
517 by fevers, against 164; and a grand total of 1786, against 1218. These
figures certainly exhibit a vast reduction in our mortality for the past eight or
nine weeks ; and when we regard the immense population now in New Orleans,
both floating and permanent, we are no less surprised than gratified at the sani-
tary condition to which our city has attained.

A CASE OF INTESTINAL OBSTRUCTION— DEATH— POST-MOR-
TEM.

On the 25th November, 1852, Win. Coleman, atat. 18, entered Ward No. 12,
Charity Hospital, complaining of intestinal pains of a griping character. He
was pale and rather emaciated ; countenance anxious ; abdomen enormously
distended and tympanitic ; no pain on pressure ; pulse feeble and frequent. No
operation from his bowels for several days ; loss of appetite ; frequent vomiting.
Was ordered a cathartic enema, effervescent draught, and sinapised cataplasm
to epigastrium.

On the 18th of November the vomiting ceased ; in other respects the same.
Was ordered an enema of warm water.

Editorial. — City Intelligence.

699

November 29th, much the same. Ordered 61. ricinif § ij, mucil. g. acac.
f § iv. M. ; to be taken by enema,

November 30th. No change in the features of the case. Ordered a full
warm bath ; also take an injection of warm water.

December 1st. Had a partial operation from bowels, with some relief. Or-
dered wine.

No change December 2d, when he was ordered an ounce of castor oil.
On the 3d, took an ounce of sulph. magnesia; warm bath repeated; ano-
dyne poultice to abdomen. Repeat enema of tepid water.

On the 4th December had a slight dejection ; repeat the castor oil. The
case continued unrelieved in spite of repeated warm baths, cath. enematas of
castor oil and oil Tereb. up to the 18th December, when growing worse he was
ordered the following :

$ Pulv. Jalap, 9i

Hydrarg. Chi. Mit. gr. xv
Pulv. Ipecac, gr. ii M.

Take at once.

During the night of the 18th December he expired, and twelve hours after
death, the post-mortem revealed the following state of the parts affected: Found
the small intestines, on laying open the abdomen, together with the caecum,
ascending and descending colon, enormously distended with gas and fceces.
The descending colon, greatly atrophied, was bound down by bands of organ-
ized lymph to the third and fourth lumbar vertebrae, at which point intussus-
ception was found to exist. The stomach was atrophied, and presented traces
of chronic inflammation. Mesenteric glands very much enlarged. Liver like-
wise reduced below its natural size and darker than natural. Beyond this the
examination was not carried.

We are indebted to Mr. Newsom, long a resident student of the Hospital, for
the preceding particulars.

Remarks — The post-mortem is defective, as it appears the intestines were
not laid open to ascertain the precise condition of the parts involved. We
have nevertheless thought proper to introduce the case, to serve as a basis for a
few unconnected observations. We would remark in the first place, that the
practice of ordering repeated doses of active purgative medicines, in cases
where intestinal obstruction is suspected, is generally inoperative, and must ul-
timately end in aggravating the symptoms. Free depletion, both local and
general, when the pulse (which is often deceptive in such cases) and other symp-
toms seem to call for the loss of blood, should begin the treatment in cases of
suspected intestinal obstructions. Having executed this, our first duty, and
thus met the most prominent indications, we may — nay, must, resort to full
doses of opium or morphine, to# favor the relaxation of the muscular coat of the
intestines. This done, a purgative both by the mouth and rectum, may deter-
mine copious alvine discharges, and relieve the urgent symptoms. To conti-
nue to fret the stomach and irritate the bowels by repeated doses of drastic
purgatives, is contrary to the best established principles of pathology, and must
aggravate the evils which they are intended to remove.

700

The New-Orleans Medical and Surgical Journal.

Some years since, we were requested by a distinguished Physician of this
city to see a case in consultation, of supposed intussusception of the bowels.
Cups, leeches, and vesication, together with purgatives, including repeated do-
ses of Croton Oil, had been administered by mouth and rectum, but without the
slightest good effect. Seven or eight days had elapsed under this treatment,
without relief ; the countenance was anxious, decomposed ; the pulse small and
thready ; the skin cold, and bathed in a cold, clammy sweat ; the extremities,
both upper and lower, shrunken and icy cold. Having seen, about this time,
some remarks in a late Dublin Medical Journal, on the success attending the
inflation of the bowels, under similar circumstances, it was determined to give
it a trial in this case. Accordingly, a gum elastic tube was introduced high
up the rectum, and the bowels were pumped full of atmospheric air. In a few
minutes the abdomen was greatly distended, and the dying patient cried " hold,
enough ;" when scarcely had the instrument been withdrawn, before the sufferer
evacuated an immense quantity of dark foetid fasces, followed by instantaneous
relief of all the unfavorable symptoms The pulse rose, the skin became uni-
formly warm and lively, the countenance calm and natural, and the patient con-
valesced rapidly from that hour.

Ths modus operandi of this mechanical agent will suggest itself to every
reflecting mind.

{Ed. N. O. Med. and Surg. Jour.)

CAUTERIZATION OF THE LARYNX IN EPILEPSY.
A. Hester, M. D.

Having seen an article in the last number of " Braithwaite's Retrospect,"
" On the relation of Laryngismus to Epilepsy," by Dr. E. Watson of Glasgow,
I send you a notice merely of other cases of laryngismus, treated in like man-
ner, about the same time, without either of the Physicians knowing of the ap-
plication of the same treatment by the other. I do this at this time, as it may
induce other Physicians to try the remedy, which is in itself innocent, but may
be the means of destroying, or partially relieving, one of the direst evils which
afflicts the human race.

While associated with Doctor Horace Green, of New York, I treated,
in connection with him a severe case of Epilepsy of more than twenty years
standing. The patient came to us for an acute affection of the throat, and was
at the time subject to from three to five attacks of Epilepsy every day. His
situation was most deplorable ; his intellect was gradually giving away ; and
from the nature of the disease, he had become an object of fear to most of his
acquaintances. The application of a strong solution of nitrate of silver was
made to his larynx and trachea, with immediate cessation of his Epileptic attack,
which did not occur again for ten days, the application being continued daily.
A periodic tendency seemed to be established at that time, the period of intermis-

Editorial. — City Intelligence.

701

sion being that of ten days, and the paroxysm continuing three days, when he
had two or three fits each day.

I left New York while he was still under treatment, but have been informed
by letter from Dr. Green, that the periods were lengthened to twenty days*
" when there is a strong tendency to their return, but a few strong applications
through the trachea will arrest them without fail."

Two other cases are now being treated by Dr. H. J. Bowditch, of Boston
who had seen the treatment of the above case in Dr. Green's office, — and with
like success. In reference to them, Dr. Green writes me, that " one, a lady,
subject to the disease for eleven years, and who had become demented, has had
the fits so far arrested by cauterizing the larynx, that her mind had been restored ,
and that she is in every respect better."

The case treated by Dr. Green will be reported in detail, in the forthcoming
number of Dr. Rees's Journal, but I feel persuaded that my giving you these
few facts alone, will perhaps attract the attention of the profession at the South,
and elicit eventually some important facts which the application of this remedy
will bring out upon the treatment of this terrible disease.

J. HANCOCK DOUGLAS, M. D.

New Orleans, February 18, 1853. ,

TRACHEOTOMY PERFORMED WITH SUCCESS.

BY DR . FOSTER

Resident Surgeon of the Charity Hospital.

An Italian fruiterer, aetat. forty-five, being constantly exposed, in conducting his
business, was attacked with laryngitis about the latter part of December, and on the
31st was admitted into the Charity Hospital. Complained of much pain and tender-
ness over the larynx, attended with dyspncea and asphyxia, hoarseness, inflamed fau-
ces, etc. Was treated with tartarized antimony ; and had his fauces touched with
a strong solution of argent, nit. The day after bis admission, the dyspnoea became
intense, with aggravation of all the symptoms. Was now ordered gr. v calomel; mor-
phia one sixth gr. every hour. Repeat the cauterization.

On the afternoon of same day, second after admission, there being no abatement
of symptoms, to which was now added lividity of face and lips, the operation of Tra-
cheotomy was deemed imperative, and was accordingly promptly performed by Dr.
Foster, the House Surgeon. The venous hemorrhage was profuse ; but soon subsided
after the trachea was opened. An "ovate curved canula was placed in the opening,
and within this one of smaller size," which can be easily removed when it becomes
obstructed with mucus. On the third day both canulas were removed. Fifteen days
after admission, the patient was discharged cured.

702 The New-Orleans Medical and' Surgical Journal*

A CASE OF SECONDARY HEMORRHAGE,

Occurring three weeks after a natural labor,— -caused by a Polypus within the

Uterus.

BY D. MACGIBBON, M. D., NEW ORLEANS.

On the 24th of December last, I was called to attend Mrs. B a young

married lady, who was in labor with her first child. The labor was a natural
one ; and was conducted while she was under the influence of chloroform. The
placenta came away, without any interference, in the usual time. Her reco-
very was very satisfactory. She was up on the sixth day, contrary to my ad-
vice, she felt so well.

On the 3d January I was again called to see her. She was suffering with
a high fever ; and had a rash out on her face, breast and arms, with crescentic
spots of healthy cuticle here and there intervening, which left no doubt on my
mind that she had the measles; how she caught the infection is still a mystery
to her. She soon recovered from this attack, and was seemingly doing well.
On the 21st January I was called on by her husband, at a late hour, who men-
tioned, that for the two preceding days some blood had come from her vagina ;
and at times so freely, that it stained through her body clothes in a short period;
also that she had for some days back been troubled with diarrhoea, which was
now severe, with pains coming and going, that caused her a good deal of suf-
fering. To check the hemorrhage and diarrhoea, I prescribed Plumbi Acetas
with Morphiae Acetas, dissolved in the camphor mixture, with a portion of
acetic acid, to be taken every hour till I should see her ; and to have cloths
wrung out of cold water constantly applied to the lower part of the abdomen-
she keeping the horizontal posture. The following morning I found her im-
proved ; all her symptoms had abated since she began the medicine. She was
much blanched, and it was evident, both from this and her description, that she
had lost a good deal of blood. She was fair complexioned and delicate looking
at the best, and I may here remark, that she had suffered a good deal from "sick-
ness" in pregnancy, and also from two falls, which hurt her left side. The last
accident occurred when within two months of confinement, and had left a ten-
der spot on the uterine enlargement, which had caused her a good deal of suf-
fering- There was also a fixed swelling at this point, according to her report;
but that I could not detect, when I felt for it on the occasion of my first visit,
when the above circumstances were related. The uterine action present might
have caused its disappearance. Be that as it may, from her having gone the
full period, I was inclined to believe, that beyond what she had already suffered,
much harm had not been done. This was strengthened by the labor proving a
natural one ; and had not the occurrence of secondary hemorrhage, at this late
period, three weeks after confinement, served to recall the circumstances, they
would have passed from my memory.

But to return. On examination per vagina, the uterus was found prolapsed,
and the os dilated so as to admit the point of the finger. A tender point was
also found on the left side, at the juncture of the cervix with the body. The

Editorial. — City Intelligence.

vagina was soft and relaxed. The finger, when withdrawn, was stained with
blood. The pulse was not disturbed.

With the use of the above medicine, and a solution of alum, which was in.
jected twice daily, the discharge gradually lessened and became paler in color,
. so that on the 26th it had all but disappeared ; when the Sesqui-chlorate Ferri,
as a useful tonic and astringent, was ordered her, in place of the former medi-
cine.

On the 27th I was called hastily to see her. Hemorrhage more severe than
ever had come on while she was asleep, and had greatly prostrated her. The
os uteri was dilated so that I could get my finger within the os internum ; and
at this situation my finger could detect a small elongated body, coming down
from the body of the uterus, but too high for me to reach its attachment or base.
This, I concluded, must be a small fibrous polypus, and mentioned what my
suspicions were.

To assist in checking the hemorrhage and expelling this foreign body, I put
her on the wine of Ergot ; and if possible to prevent any further flooding, the
vagina was plugged. She was ordered to have port wine freely, with light
nourishing food.

There was no return of hemorrhage, but a saneous discharge, which had
an offensive odor, remained for several davs. The following notes, which I
extract, will best describe her condition from this period, when her symptoms
became greatly aggravated.

Feb. 2. The husband called on me this morning, prior to my visit, and
mentioned that she had felt much disturbed all night ; besides the previous
pains in the abdomen, she had much irritation of stomach, and had been vomit-
ing a good deal ; ordered her the following medicine :

fy. Sulph. Morph. gr. ii

Acidi Hydrocy. dil. gtt. xxiv

Aqua Cinnam. f iss M.

A teaspoonful every hour as long as the pain and vomiting continue.

I saw her shortly after, and found her moaning and complaining much of a
steady pain about the umbilicus and in the back ; tongue also with more of a
yellowish coating. She had not a passage from her bowels the last twenty-
four hours, and a gentle cathartic enema was administered to relieve them.
The above medicine was continued, and a liniment, consisting of two fluid
ounces of chloroform, and one ounce of pulverized spermaceti, was to be ap.
plied to the parts where the greatest uneasiness should be felt. She was evi-
dently much distressed, and this, with the want of proper rest during the night,
had exhausted her a good deal. She had hitherto continued to suckle her child,
but that is to be given up. Iced milk for diet, but she does not care much for
any thing.

At 3 P. M. I again saw her. The enema had brought away some feculent

704

The New-Orleans Medical and Surgical Journal.

matter ; and she passed from her vagina a white body, not easily broken up,
about the length of her little finger, and smaller in diameter. This, which
she intended to keep till I should see it, was inadvertently thrown out by the
nurse ; but from the minute description she gave of it, I have little doubt it
was a small fibrous polypus from the cavity of the uterus, as suspected. Since
she began the medicine and liniment all her symptoms are greatly relieved,
and she feels more cheerful Slight vomiting occasionally occurs, and that
which is ejected is greenish looking and bitter. No tampoon had been in the
last two days. Discharge the same as previously.

3c?. She suffered a good deal from pains in lower portion of abdomen and
small of back all night, and rested but little.

The liniment was occasionally applied, but she did not use much of the mor-
phine solution. She complained of this and other things burning her stom-
ach. Is much exhausted looking, and tosses about, moaning " oh Lord." Her
pulse is 84, and regular; in no way indicative of inflammatory action, though
she wont believe but her inside is being destroyed, and that she wont re-
cover. Ordered her to get port wine negus freely. This she previously took
readily, but the last day or so refused. After partaking of the wine and the
morphine solution ; and getting an enema containing a teaspoonful of lauda-
num in three ounces of starch mucilage, to assist in allaying the uterine irrita-
tion, her symptoms abated, and she revived some in spirits. Viewing the case
as one to be treated with narcotics, to allay the nervous derangements conse-
quent on the uterine disease, till this is thrown off, I determined to give them
freely. As, however, the morphine does not suit the present congested state
of the stomach so well, and one grain doses of that are now required to produce
much effect, I ordered the Indian Hemp to be substituted ; one scruple of the
extract to be dissolved in half an ounce of strong alcohol, and fifteen drops of
this to be administered in a little water every hour, till her symptoms be re-
lieved. The wine and the iced milk to be continued ; and the liniment as be-
fore externally.

I saw her again in the afternoon , and found that the Indian Hemp (obtained
from Sickles) had immediately soothed all her sufferings. She slept a good
deal; but would occasionally wake up— complain of pains — ask for her drops,
and go to sleep quietly. She continued this medicine in the same doses freely
for three or four days after this ; during which she consumed nearly two scru-
ples of it, without its giving rise to any headache or other annoyance. She
seemed to be again doing well ; the discharge had all but disappeared ; the os
felt normal, and the tender point left. The tongue, however, remained stil
coated, and her appetite did not improve much.

On the 8th her symptoms again became aggravated. She had pains in all
her former quarters, and now these extended up to the mamma? also. She had
been up for a short time the preceding day, and I suspect this had something to
do with the relapse. She was suffering at my visit very much. The Indian
Hemp was again resorted to, and in twenty drop doses, as in the former quan-
tity it did not sooth as at first, This, with ananodyne enema, and the liniment

Editorial. — City Intelligence.

705

externally, soon relieved her, and in a few hours she was much better. Her
pains, like all neuralgic pains, had from the first been more or less intermittent
in character.

On the 13th, she was so far improved in general health as to be up and mov-
ing about her room, with all her feelings better than they had been since her ac-
couchement.

With careful nursing she soon became restored in health and strength. She
continued the iron drops, and this, with nourishment, enriched the blood, and
brought back some color to her lips and cheeks. The milk also returned,
though not in quantity sufficient to satisfy her child's wants, who, with its mo-
ther, promises, to all appearance, to do well.

New Orleans, February 2 1st, 1853.

MORTALITY IN THE UNITED STATES NAVY.

Recent intelligence, gleaned from the daily prints, notify us that our naval
vessels, stationed at Barbadoes, have been severely scourged by the yellow fe-
ver. The steam frigate Dauntless lost in a few days of the fever eighteen offi-
cers and ninety men — a fearful mortality for the crew of a single vessel. Our
government, when about to order our nautical vessels to stations subject to the
ravages of yellow fever, or any other violent disease, peculiar to tropical lati-
tudes, should take the precaution to select such medical officers as may have
practical knowledge of the character and treatment found by personal experi-
ence and observation, best adapted to such cases. However well qualified and
otherwise skilful in the general practice of physic and surgery, they must
have some experience in the treatment of yellow fever, and other tropical dis.
eases, to meet and contend successfully with them at the bedside. The fearful
mortality recorded above, should direct the attention of the Secretary of the
Navy, or at least the Chief of the Navy Medical Board, to this important sub-
ject. It is a question of life and death to our brave seamen and gallant naval
officers ; and without aiming to detract in the least from the high attainments
of the naval medical staff, we feel satisfied that the welfare of the service and
the interests of humanity would both be promoted by selecting medical men
practically acquainted with yellow fever, to take charge of such vessels as
may be ordered to stations where this and kindred fevers are known to prevail.

LOUISIANA STATE MEDICAL SOCIETY.
Whilst directing the attention of the Physicians of Louisiana to the ts Circular" of
the President of this Society, (inserted among our advertisements) we embrace the
occasion to urge upon the Medical Faculty of this State, the necessity of sending at
least one representative for each parish. We invite all who can leave their homes,
to be present on that day, and take part in the deliberations of the Society.

706

The New-Orleans Medical and Surgical Journal.

PROSPECTUS OF MASSIE'S ECLECTIC SOUTHERN PRACTICE.

We are gratified to perceive, from the "Prospectus" before us, that we are
about to be favored with a work on the Diseases of the South, by a gentleman
every way competent for the undertaking. Dr. Massie, of Texas, has been so-
licited by a large number of his brother practitioners, who are well acquainted
with his high qualifications, to write a work on the Theory and Practice of
Medicine — a work " presenting the various modifications which diseases as-
sume in Texas" (and the South generally. — Ed.) The material for such a
work is varied, abundant, and needs but some skilful hand to gather the rich
harvest which is now ripe, to digest and arrange it for our common profession.
As yet little has been done, save through the pages of a few medical periodi"
cals,to advance, in the estimation of our cotemporaries, the science of Medicine
in the South. For works, whether in Surgery or the Practice of Medicine,
we have heretofore looked to friends of the North and of Europe; when
we should begin to put forth our own efforts, and build up a system of practice
adapted to our climate, the peculiar nature of our diseases, and the wants of
the profession. Facts in abundance are at hand, as rich as they are diversi-
fied— diseases unknown to other latitudes and other climes daily fall under our
observation, and demand our care, yet we have but few records, and no stan-
dard work, to which we can turn for instruction and advice, treating of our pe-
culiar diseases, in times of doubt and difficulty. To possess a work embody-
ing the history, the peculiar features of our epidemic and endemic diseases,
and also their pathology and therapeutics, is indeed a desideratum which has
long been felt by the profession throughout the South. We are rejoiced, there-
fore, to learn that a Physician—a man of, and belonging to us— one of exten-
sive experience, enlarged and liberal views — of much reading and reflection —
a scholar, in short, is about to undertake to supply this desideratum to the
profession.

The work will be brought out in. the course of twelve months, at least, the
price of which will be fixed at five dollors per copy.

We look forward to the appearance of Dr. Massie's new work with unusual
interest, and shall hail its publication as the establishment of a new epoch in
Southern Medicine.

OCEAN SPRINGS, LYNCHBURG, MISS.

We have, in a former number, called attention to an analysis of these wa-
ters by Prof. Smith, and also alluded to their great efficacy in certain forms of
chronic diseases ; we spoke at the time without sufficient data on the subject
to justify any unequivocal declarations, because a sufficient number of well
ascertained facts were wanting. Since however we made those remarks, evi-
dence of an unquestionable character has been laid before us by Dr. Austin,
fully demonstrating the superior efficacy of these waters in chronic diarrhoea,

Editorial. — City Intelligence.

707

scrofulous complaints, dyspepsia, general debility, and almost every variety
of nervous complaints, in which the martial preparations might prove ser-
viceable.

This evidence, from many highly respectable Physicians, will be given to the
public in pamphlet form, in a few days, by our estimable, friend, Dr. Austin, of
this city. From the facts already brought before us, attesting the superior vir-
tues of these waters, we venture to predict that these Springs, when fully found
out, will supersede in public estimation any East or West in the United
States.

CHOLERA.

At last we are about to be rid of that scourge of the four quarters of the globe
— the Cholera ; it has, we would fain believe, accomplished its work of death j
fulfilled its mission, under Providence, and departed from among us. In no part
of the United States does it prevail to any extent; it has spent its force — dried
up the fountains of life in millions of subjects — swelled the bosom of the earth
with its victims — made desolate the hearts and households of thousands of fa-
milies, and gone forth to other climes — to other regions, to renew the contest
for life or death with the sons and daughters of mortality. Cholera ! its mere
name sends a thrill of horror to the heart of the brave as well as the timid; to
many it will convey sad recollections and heart-rending reminiscences, of
friends, relatives and kindred, who were cut ofT from earth by the Great De-
stroyer. But why pursue the subject ? Let the past be forgotten.

Quis ialia fando, * * temperet & lachrymis ?

* * * animus meminisse horret, luciuque refugil ?

We trust we have seen the last of this scourge ; let us hope that it has de-
parted from us forever !

708 The New-Orleans Medical and Surgical Journal.

REPORT OF THE CHARITY HOSPITAL,

(NEW-ORLEANS,)

For December 1853 and January 1853.

JAN.

SEX.

dec.

Admissions -

Males

1178

Do. - -

Females

290

- — 1468

U X »o \j 11 A. XV Ijr Hj o •

ITldlCO

1 026

Do. - -

Females

244

1276

Deaths - -

Males

146

Do. - -

Females

180

Births - -

Males

Do. - -

Females

Still-born -

Number remaining on the 1st January, 1853, 980
" " » 1st Feb. * " 957

CALVIN PORTER, Ass't Clerk.

ABSTRACT OF A METEOROLOGICAL JOURNAL FOR 1852.

BY D. T. LILLIE & Co., at the City of New Orleans.
Latitude, 29 deg. 57 min. ; Longitude, 90 deg. 07 min. West of Greenwich.

COURSE

FORCE

°5

Quantity

WEEKLY.

thermometer.

BAROMETER.

OF THE

j_ at
03 Q

OF THE

WIND,

RAIN

1853.

WIND.

Ratio

Max.

Min.

Range.

Max.

Min.

Range.

1 to 10.

Inches.

Dec. 23

78 .0

46 .0

32 0

30.40

30 .05

0.35

SW.

2.50

0.035

" 30

80 .0

40 .5

39 5.

30.40

30.10

0. 20

2.00

0.600

1853

Jan. 6

65.0

37 .0

28 .0

30 .40

29 .90

0. 50

N. .

3.00

0.000

« 13

66.0

47 .0

19 .0

30.22

30.00

0. 22

2.28

0.860

« 20

53 .0

38.0

15.0

30 .40

30.00

0.40

3. 40

2.765

» 27

59 .5

38 .0

21.5

30.63

29 .90

0. 73

NW.

3.07

0.380

Feb. 3

71 .0

38 .0

32 .5

30 .60

30.00

0. 60

1 .85

0.025

» 10

73 .0

37 .0

36 .0

30 .23

30. 00

0.27

NE.

2 .72

3.820

» 17

74 .0

46 .0

28 .0

30.16

30 .00

0. 16

2. 64

0.370

" 24

68.0

43 .0

25.0

30.40

29.60

0 .80

3.35

1.185

The Thermometer used for these observations is a self-registering one, placed in
a fair exposure. Regular hours of observation : 8 A. M., 2 P. M., and 8 P. M.

CIRCULAR.

To the Medical Profession of Louisiana,

In the year 1850, many of your fellow Physicians, after patient consideration, pro-
ceeded to the formation of a State Medical Society for " the elevation of the char-
acter of the Medical Profession, the protection of the interests of its members, the
promotion of Medical Science, and the diffusion of information upon collateral sub-
jects," with the strongest hopes of bringing all Physicians in good standing through-
out the State, to share in the responsibilities and privileges of such an Association.

We do not need the antecedents of similar and successful organizations in other
States of our great Union, to stimulate us to imitate their works in the common cause
of medical advancement, although it is peculiarly grateful to us to acknowledge the
disinterested and arduous labors of our " confreres" every where, in preserving the ho-
nor and usefulness of our noble profession ; consecrating their time and opportunities
in establishing its claims to the confidence of enlightened communities, and bequeath-
ing imperishable legacies, derived from their toil and self-denial.

The demands upon every right-minded member of the profession within our geo-
graphical limits, in view of our almost isolation beyond the city, require that we
should make mutual concessions, and even incur personal inconvenience, to promote
the objects we have in view.

Many considerations will occur to every intelligent physician, to fix his determina-
tion to sustain this new movement among us, and one that is at this time urgent is
the repeal of the License Law ; by which injudicious measure, we are excluded from
a correct knowledge of every respectable practitioner, with whom it would be a source
of pleasure to fraternize, and introduce to the professional public as a co-laborer, wor-
thy the esteem and confidence of ous; intelligent Faculty throughout Louisiana.

Many other valid reasons might be assigned, wholly inexpedient to the design of a
" Circular," why you should deem the present moment as one especially opportune
to exercise your influence in fostering the "Louisiana State Medical Society," and
by your presence at its annual meetings, mingle in the debates, and impart informa-
tion derived from your particular circle of observation ; and, in returning to your field
of labor, imbued with the fruits of that free interchange of views and facts, gathered
from the great Medical Assembly of the State, thus contribute to enlarge the sphere
of its usefulness.

You and other physicians of your neighborhood, now unknown to the officers of
the Society, are therefore earnestly and cordially invited to be present at the fourth
annual session of the " Louisiana State Medical Society," which will be opened in
the Medicall Hall of the University, in the city of New Orleans, on Monday, the
fourteenth day of March, 1853, at twelve M.

N. B. All physicians who may desire to be present on the above occasion, are re-
spectfully requested, on their arrival in the city, to repair to the Medical Hall in Com-
mon street, between Baronne and Philippa streets , and record their names and ad-
dress.

Respectfully,

J. M. W. Picton, M. D., President.
John Farrell, M. D., Vice President.
Edward Bein, M. D., Vice President.
J. C. Simonds, M. D., Cor. Sec'y.
J. G. Browning, M. D., Rec. Sec'y.
Richard C. Bolton, Treasurer.

Louisiana State Medical Society.

FRESH VACCINE VIRUS.

Dr. E. D. FENNER, (No. 5 Carondclet street,) will continue to supply the Pro-
fession and community with fresh and genuine Vaccine Matter. Orders by letter
promptly attended to.

New Orleans, November 1st, 1852.

THE NEW- ORLEANS

MEDICAL AND SURGICAL JOURNAL

MAY, 1 853 .

|p art JFirst.

ORIGINAL COMMUNICATIONS.

L— ORDER OF HIPPOCRATES.

BY ALBERT WELLES ELY, M. D. NEW ORLEANS.

All great interests, whether political, moral, religious or scientific*
freed organizations to sustain them. Indeed such, we may say, is the
law or order of nature ; for the Creator has accompanied, or brought
about, the development of every principle by means of organizations,
Every thing about us, whether in the physical or moral world, is con-
nected with, and developed by, organizations. Through organization
the principle of all manner of life is developed ; through organization
humanity, considered in its highest transcendental aspects, is developed;
and through organization mind, the only substantial reality and substra-
tum of every thing, is also developed. Look where we will, about us
and in us, and we see nothing but organization as the means of giving
force and reality to all the known great principles in existence.

Order is nature's first law; but order is organization ; and God has
not only introduced it into the physical world, for the development of
life and the powers of mere matter, but he has set the example of de=
veloping and protecting by it the greatest of all moral intereste^-reli*

710 The New-Orleans Medical and Surgical Journal.

gion. For its development and protection God considered that religion
needed the organization of the Church, or else he would not have
founded the Church. We speak here of no particular Church, but of
the Church in general ; and all we wish to show is, that all great in-
terests need organization, as a means of progress, improvement and
protection.

The experience of all times and nations shows, that every great
interest has ever flourished most under some form of organization ;
and at the present day, systems of organization for the promotion of a
cause characterize the age. The influence of organized association
in advancing objects of utility, is too apparent to all to need specifica-
tions. We shall therefore only endeavor, in this paper, to show in
what way one of the greatest of causes—that of Medicine — can be
advanced and protected by means of organization. It may be said that
it has organization already. We grant it ; we know very well that it
has Medical Societies, Medico-Chirurgical Societies, and Societies and
Associations of different names, almost without number ; but all these
isolated organizations do not and cannot accomplish the great objects
of medicine. They do not advance its great interests, because, being
isolated, their influence, good as far as it goes, is confined to a very
limited sphere of action. The great interests of medicine and of the
medical world require something more general in its nature — an or-
ganization that shall embrace the whole medical world as a field of
action.

Now, what kind of an organization can that be, of this general na„,
ture, extending its influence over the whole medical world, and concen-
trating within itself powers that shall be efficient and acknowledged
by all? Nothing less than a great Medical Order — something like
that of the Masonic Order, or the Order of Odd Fellows. We wish to
be understood — to come to the point. We mean to say, that the great
interests of the Science of Medicine require the establishment of a
great Medical Order, having one great head, to which all others
shall be subordinate. We have chosen to give this order a name — tha^
of the Order oj Hippocrates ; but some other might, perhaps., be better.
Our idea of the organization of this great order is as follows : It should
consist of divisions, called subordinate Colleges, deriving their charters
from one Grand College, for the whole United States, holding its ses-
sions quarterly, or semi-annually, in some central point of the Union.
The order should be strictly secret, and all initiations into it be unifom.
All laws regulating the Order should emanate from the Grand College of
the United States.

Dr. Ely on the Order of Hippocrates.

711

The form and ceremonies of initiation should be of the most solemn
and imposing character, accompanied with oaths or obligations binding
the initiated to sustain the interests of the Order.* Degrees should also
be instituted, the attainment to which should depend on proficiency-
made in certain branches of science specified by the laws of the Order.
These branches of science should not be limited to medicine alone, but
embrace, as the degrees become higher, the entire field of human
knowledge, the candidate for the highest degree having passed over the
entire field of the physical and mathematical sciences, and through all
the other departments of the most extended University course of educa-
tion. This would make the Order not only a medical order, but a
learned order. j"

* The Asclepiadse, the descendants of iEsculapius, and who were very strict as
to the medical qualifications and conduct of their pupils, bound them by the celebra-
ted Hippocratic oath, said by some to have been drawn up by Hippocrates himself,
or at least to have been nearly as ancient. It was as follows: I swear by Apollo*
the Physician, by iEsculapius, by Hygeia, and Panaceia, and all the gods and god-
desses, calling them to witness that I will fulfil religiously, according to the best of
my power and judgment, the solemn promise and written bond which I now do
make. I will honor as my parents the master who has taught me this art, and en-
deavor to minister to all his necessities. I will consider his children as my own bro-
thers, and will teach them my profession, should they express a wish to follow it,
without remuneration or written bond. I will admit to my lessons, my discourses,
and all my other methods of teaching, my own sons and those of my tutor, and those
who have been inscribed as pupils and have taken the medical oath ; but no one else
I will prescribe such a course of regimen as may be best suited to the condition of
my patients, according to the best of my power and judgment, seeking to preserve
them from any thing that might prove injurious. No inducement shall ever lead me
to administer poison, nor will I ever be the author of such advice ; neither will I con-
tribute to an abortion. I will maintain religiously the purity and integrity both of my
conduct and of my art. I will riot cut any one for the stone, but will leave that ope-
ration to those who cultivate it ; ('sxawpyjow os spy asryifiv avSpatfi <7rp?]£ioS rv\oSe)
Into whatever dwellings I may go, I will enter them with the sole view of
succoring the sick, abstaining from all injurious views and corruption, especi-
ally from any immodest action towards women or men, freemen or slaves. If, during
my attendance, or even unprofessional ly in common life, I happen to hear of any
circumstances which should not be revealed, I will consider them a profound secret f
and observe on the subject a religious silence. May I, if I rightly observe this my-
oath, and do not break it, enjoy good success in life, and in my art, and obtain gen-
eral esteem forever ; should I transgress and become a perjurer, may the reverse be
my lot."

t We deem it quite unnecessary to enter into an argument to show the necessity of
high education to a physician, since the progress of medicine involves a knowledge of
so many collateral sciences. This the mere tyro in medicine must readily perceive.
It must be observed, however, that many of the unprofessional have adopted the

712

The New-Orleans Medical and Surgical Journal.

Certain privileges and distinctions should also accompany each degree
and also certain obligations. There should be an initiation fee, and
certain monthly dues from the members. The monies thus collected
to be appropriated to the support of all needy and worthy members of
the Order. A regular system of signs, grips and pass-words should
also be introduced, by which a member of the order could be re-
cognized.

Secrecy, which tends to give stability and influence to all orders,
should be a special feature of the Order, and violated only with the
marked disgrace and expulsion of the member thus offending. There
has always existed opposition to all secret orders ; but this opposition
has always proceeded from a spirit which is disposed to resist an order,
whether secret or not. We may safely affirm that secrecy is, if not
constantly, at least often necessary in all institutions. It is the only
way to guard against disorganizing outward tendencies and influences,
which, if not shut out, would often prevent the accomplishment of the
most important measures. Hence the frequent " secret sessions" of
legislative bodies. Secrecy is the only means by which the members
of an order can be bound together for the accomplishment of a great
purpose ; it gives a unity to every measure, and secures its universal
and simultaneous accomplishment, untrammelled by any outside influ-
ences. Moreover, it cuts off the intermeddling of all those who are
not directly interested. It enables things to be accomplished which
could not be accomplished amid the conflicting opinions of an open and
promiscuous assembly, where a thousand outside influences modify the
vote of some, and silence altogether that of others.

These are some of the reasons, and we deem them sufficient, why
the Order which we propose should be a secret one. There are many
others which might be enumerated.

That all who are not already M. D.'s might partake of the benefits
of the Order, its first four degrees, which should be conferred each only
at intervals of one year, should embrace a thorough course of medical
studies ; the first degree requiring one fourth of the course ; the second,
one half ; the third, three fourths ; and the fourth, a knowledge of the
whole course, which fourth degree would be that of Doctor of Medicine.

ridiculous opinion, that neither much education nor much natural talent is necessary
for a doctor ; and so those sons, supposed by their fathers to possess only moderate
abilities, are consigned to the study of medicine, the most difficult and incomplete of
all sciences ; while the " smarter lads" are supposed to be capable of unravelling the
knotty points of the law.

1 ' ' (

Dr. Ely on the Order of Hippocrates.

713

No person, therefore, could take the first degree, or in other words, be
initiated into the Order, without the prescribed medical qualifications;
nor could he advance in the Order without close application to the at-
tainment of the requisites for each degree.

Those already found to be, on due and strict examination, Doctors of
Medicine, could be initiated and passed immediately to the fourth degree.
They are then to rise, at intervals prescribed by the rules of the
Order.

The other degrees of the Order should not be less than twenty-six in
number, each distinguished by a name and appropriate badge ; and no
one should be allowed to take a degree except by the vote of those hav-
ing already taken it, and after standing well a thorough preliminary ex-
amination in the branch of science prescribed.

Such is a brief outline of one of the most important orders that
could be instituted— of an order which, if faithfully adhered to, would
elevate medical science, and render the medical profession what it
ought to be— a learned profession. It would give unity and harmony
to the medical world, and draw so broad a line between the true Phy-
sician and the charlatan, that all the world could see it.

The necessity for the adoption of some mode of protecting the dig-
nity and interests of the medical profession, is found in the fact, that
while the laws most amply extend their support to the protection of the
legal profession, they, by special legislation, have withdrawn, at least
in Louisiana, all protection whatever, and all encouragement, from the
medical profession. The present laws of Louisiana ignore all distinc-
tion between regularly educated Physicians and the most notorious and
barefaced quacks and impostors. They allow any one to impose upon
the public, and to trifle with human life, who choses so to do, provided
he can exhibit a diploma from any respectable medical school — a re-
quirement which now, unfortunately, it is easy to comply with, since
all medical schools are equally respectable in the eyes of the law, and
since, through the fault of the profession itself, diplomas are granted,
annually, by the hundreds, to candidates whose qualifications must ne-
cessarily be extremely superficial — for the idea of acquiring a sufficient
amount of medical knowledge, in the prescribed time of two years, is
absurd. We do not wonder that the law and the public have set so low an
estimate on the medical profession, after seeing with what ridiculous haste
it confers its degrees on the hundreds of unlettered men who throng
the medical colleges, so called , and bear off so easily and so cheaply
the burlesque honors of the profession. After falling into such a sys-

714 The New-Orleans Medical and Surgical Journal.

tern, the medical profession could hardly expect that the laws- would
afford them any protection.*

Lowered as the medical profession certainly is, by the system into
which it has fallen, there is no use in trying to palliate and defend it.
It is time now to speak out, and to make an effort to retrace our steps.
There may be a difference of opinion in regard to the manner in which
this is to be done ; but we conceive that the establishment of a Medical
Order would be an efficient means of accomplishing the object. It
would bind the profession together, elevate the standard for medical
proficiency, raise up a combined force throughout the Union for the sup-
pression of charlatanism, and add greatly to the dignity of medicine as
a profession. The Order would be the judge of the qualifications of
members of the profession, and extend its countenance and support to
those only, who, after strict examination, were found worthy. Such,
and such alone, would be sustained by the Order, out of its funds, if
necessary. The Order would be, in fact, a brotherhood, sworn to mu-
tual protection and support, upholding the worthy, and punishing with
disgrace all gross unprofessional conduct. The public and standing
arrangements of the Order would inform the world who were worthy
of confidence as Physicians ; and these announcements would soon
become the received guide of the public, and concentrate all practice in
the hands of the Order.

A writer in the Southern Literary Messenger for December, 1852
whom we believe to be an Assistant Surgeon in the U. S. Navy, com-
ments very freely and justly on the state of medical education in the
United States, while alluding to the laws of Brazil on the subject. The
Brazilian student of medicine is required to master a course of study
of seven whole years before he is able to obtain a diploma. Thorough
education, and an amount of knowledge which commands the respect
and confidence of the public, and honors the profession, is the result ;
affording, however, a very striking contrast with the disgraceful sys-

* Truth requires us to add, that some medical colleges fix their " diploma fee"
at thirty dollars ; which high rate has the effect of lowering the standard for gradua-
tion. For the sake of the thirty dollars, there is no particular solicitude felt for the
proficiency of the student applying for a diploma. The " faculties" are manifestly
interested in "passing" as many as possible. Forty graduates at thirty dollars, would
be twelve hundred dollars — a handsome little sum, well worth saving. To clear
themselves of all suspicion, medical faculties ought to make no charge, or at least, a
merely nominal one, just sufficient to pay the expense of the parchment ; and in jus-
tice, we must say, that there is at least one medical school in the South, which
does so.

Dr. Ely on the Order of Hippocrates.

715

tern now generally adopted in the United States. So truthful are the
observations of the writer in the Messenger, that we cannot refrain
from giving the following quotation :

" It is lamentable to see," says he, "how falsehood and credulity conspire to de-
lude and cheat the people in medicine, in surgery, in politics, and even in reli-
gion, and how little encouragement masses of men give to absolute truth and in-
tegrity.

" For thirty years and more, the system of medical education, pursued in the Uni-
ted States, has tended to lessen the amount of knowledge required by colleges to se-
cure the diploma, a certificate to the public that their alumni respectively were true
men, worthy of confidence and trust in all things pertaining to the art and mystery
of removing disease. Indeed it is nearly thhty years since it was ascertained in the
military services of the country, that the diploma of colleges is not a reliable docu-
ment, and that this certificate, purporting to embody the testimony of trustees and
professors, men elevated to their positions in consequence of their integrity and learn-
ing, could not be trusted. Hence the Government, for once, in advance of the know-
ledge of the day, disregarded the diploma, and employed only such persons in the
medical department of the Army and Navy as were pronounced competent by
boards of experienced medical officers, appointed to examine them. In the early
days of these examinations not one fourth of the candidates examined were found
qualified ; and even now not much more than one half of those examined are passed;
yet all, or nearly all, who present themselves, are armed with diplomas or certifi-
cates to the public that they are fully instructed and capable to practice medicine and
surgery, as occasion may require.*

"Still the evil goes on. Medical schools are multiplied in almost every section of
the Union ; they resort to various means to attract the pupils, and in some instan-
ces they rival each other in facility of granting diplomas. Such institutions believe
they find both their renown and profit to be in proportion to the number rather than
in the learning of their graduates ; and this system is tending to lessen the respecta-
bility of the medical profession, and to encourage quackery, imposture and credulity;
and the only hope of eradicating this state of things is in the American Medical
Association, which will in time, perhaps, enlighten the public as to the true charac-
ter of certain institutions, which, under the pretext of teaching medical science, are
obtaining money under false pretences, and indirectly colluding to poison and kill in-
nocent members of the community. If the influence of the respected and respect-
able members of the profession proves insufficient to protect the public from such im-
posters, a general law, inhibiting any person from practising medicine or surgery for
profit, except by license obtained on the certificates of boards of examiners, appointed
by the executive or legislative authority of the States respectively, might be effec-
tual. The profits of such a board should be independent of the result of the exami-
nation. Its members should look only to the interests of the community, and with-
out fear or favor of candidates for license to practice."

* The multitude of these rejected doctors, pronounced by the U. S. Medical Exam-
iners unfit to be entrusted with the lives of the sick of the Army and Navy, are ne-
vertheless rendered, by the laws of Louisiana, fully competent to prescribe for the
good citizens of Louisiana !

716

The New-Orleans Medical and Surgical Journal.

The writer very candidly and justly admits, that there are Physicians
and Surgeons in the United States, who, for skill and dexterity in the
healing art, are not surpassed by those of any other country. Every
candid medical writer will admit this ; but no thanks to our " medical
schools" for it. Our numerous Physicians, justly distinguished for their
skill and extensive medical knowledge, owe their distinction to their
laborious and long protracted studies and practice, and to nothing else
—a conclusive proof that the present " fast" system of grinding out an-
nually, from " medical schools," batches of hundreds of M. D.'s, is a
cheat, a humbug, a lie — a monstrous and murderous imposition practised
upon the public.

Can it be possible that the Legislature of Louisiana that enacted
the present medical law of this State, which admits all to practice me-
dicine who have diplomas, were aware of the fact, that for the last thirty
years the United States Government have ceased to recognize a di-
ploma as evidence of medical capacity ? If they were, they should
have given the fact some heed.

We do not agree with the writer quoted above, that our only hope of
reform lies in the American Medical Association ; for we do not believe
that that Association has an organization which will enable it to reach
all the wants, and to crush all the abuses, of the profession. It can do
nothing more than has been attempted by the enactments of Legisla-
tures on the subject, and it is well known that these enactments have
for the most part failed. The American Medical Association may re-
commend wholesome measures ; but it has none of those means, com-
mon to secret orders, for enforcing them. It is not a brotherhood, and
therefore no individual of the profession feels himself bound to it by
any ties whatever. He can look to it for no support — no protection — *
no operative sympathy. It can enforce nothing; it can only recommend;
and that we can all do.

What the great interests of the profession requires is an Order^ al{
of whose members are pledged, by their sacred honor, to carry out the
measures of the Order through the means prescribed- — all being bound
together by solemn obligations to defend one another and the interests
of the Order, by all lawful means. Such an Order as that we recom-
mend would soon extend its ramifications into all parts of the Union,
and soon exhibit its effects upon the profession.

We cannot, of course, enter into a development of all the internal
regulations and modes of action of such an Order, since strict secrecy
is to be its prominent characteristic ; the details will readily suggest

Dr. Mitchell on Yellow Fever.

717

themselves to those conversant with Orders already existing. The
rapid success of existing Orders, and the many benefits resulting to
society from them, show their efficiency as instruments of good. They
extend to cases which the laws cannot reach, and they carry out their
measures by a unity of action, and a systematized graduation of pow-
ers, which operate alike on all and in all places.

There is a general feeling among the members of the profession,
that certain radical reforms are very much needed. Abuses have been
carried so far, that a general alarm begins to be felt. A remedy is
loudly called for. We respectfully invite the attention of the medical
profession to an examination of the remedy which we propose, and
hope that this paper will call the attention of the more prominent mem-
bers of the profession to a careful investigation of the subject.

II. — WHY HAS YELLOW FEVER CEASED TO VISIT PHILADELPHIA
AS AN EPIDEMIC f*

I close the discussion of the doctrine of contagion, with this most sig-
nificant quere. A concise response will develop the entire merits of
the controversy, and leave not an inch of ground on which to rest the
point, so long and so strenuously maintained by a small portion of the
medical profession. Why has yellow fever failed to visit the cities of
Philadelphia and New York, as an epidemic, for nearly one fourth of a
century ? Can this interrogatory be solved satisfactorily, by the believ
ers in contagion and importation ; and if not, can the advocates of do-
mestic origin and non-contagion offer a plausible solution of the prob-
lem ? This is a grave suggestion.

History has recorded the desolations of Philadelphia in 1793, and
subsequent years, down to 1800, by the terrible scourge of which we
are speaking. In less than three months, between three and four
thousand persons perished in that city in the year first named, and in
one or two seasons subsequently, the mortality was nearly as great. It
will appear from a reference to the census, that the population of Phi-
ladelphia in 1793 did not exceed 50,400, whereas in 1850 it exceeded
400,000. Here we find a vast augmentation of subjects, on which a

* Extract from Manuscript on the " Fevers of the United States of America," by
Thomas D. Mitchell, M. D., Professor of Theory and Practice in the Kentucky
School of Medicine.

718

The New-Orleans Medical and Surgical Journal.

truly contagious disease, if imported, could not fail to exert a terrible
influence. It is hardly necessary to state, what every reflecting man
would naturally expect, that the commerce of Philadelphia increased
with its population ; not only do more vessels visit foreign countries,
but the voyages are more numerous by reason of the improvements in
shipbuilding now than at any former period ; and between 1793 and
1853, the disparity in this respect is incredibly great.

In view of these historical facts, which cannot be controverted, it is
quite obvious that our quere grows in importance. A very few years
after the settlement of Philadelphia, when its population did not exceed
1500, yellow fever was exceedingly fatal ; and the most prominent phy-
sician, Dr. Bond, endeavored to convince the people, that a ship, just
from Dublin, full of Irish emigrants, imported the disease.* And in
later years, when the disease made more serious havoc; because of aug-
mented materiel, the same mode of accounting for its appearance has
been resorted to ; and hence our quarantine laws. Was yellow fever
raging in any foreign port to which vessels of the United States con-
stantly trade, and did the disease make its appearance in Philadelphia,
it was traced by not a few, directly to this or that distant seaport, and
the credulous received the announcement just as if it were a problem
mathematically demonstrated.

Now, every Philadelphian knows that yellow fever has not been
heard of in that city, as one of its epidemic affections, for nearly a
quarter of a century. If it has been there at all, even sporadically, the
populace did not know it, and of course there was no popular tumult
like that of 1793, and in subsequent years, down to 1800. And what
is most remarkable in all the history is the fact, that the population and
commerce have been all the while rapidly growing, why then this pro-
longed absence of yellow fever ? On their own principles of contagion
and importation, can the advocates of these doctrines furnish a satis-
factory solution ?

But we have quite important data of recent date, to present in this
relation. Although it suited well enough for the support of a mere
theory, to assert that yellow fever never appeared in Rio Janeiro,
where intermittents and remittents have long been familiar, only a few
months elapsed after the appearance of an elaborate paper in the Ame-
rican Journal of Medical Science on this very point, ere one of the
most terribly fatal epidemics of this very yellow fever the world has

* See Watsdn's Annals of Philadelphia.

Dr. Mitchell on Yellow Fever.

719

ever known, broke out at this same Rio. The London Lancet has re-
corded the fact that in 1850, not less than ten thousand persons fell
before this awful pestilence, and that in ten days in the month of April,
1851, no fewer than eleven hundred victims were borne to their final
resting place ; and all this in Rio Janeiro, a port with which we have
constant intercourse. And in addition to these facts, we may notice
very properly the unusually frequent announcements in our newspapers
of the ravages of yellow fever in Martinique, in Porto Rico, in Sain^
Thomas, and in various places which our merchant vessels are visiting
several times in each year. Indeed the information to which we refer
is brought into Philadelphia, directly, from the places referred to, by her
own vessels. Such has been the real state of the case, throughout the
year 1852, as well as in preceding years.

Perhaps the contagionists and importers will tell us, that some other
disease, and therefore not yellow fever, has done the mischief referred
to above. But this device has grown so stale, and is worn so literally
threadbare, that it can be treated only with contempt. Unfortunately,
the disease under review has been too well known to be for a moment
a problematical thing in the islands named above, and in various other
places, where its visitations are looked for every year, as a matter of
course. The people have a painful realization of the unwelcome truth,
that the disease is an epidemic of their locality, and of course not an
imported calamity.

Does the quarantine system of Philadelphia protect the citizens of
that place from yellow fever ? Who that knows the facts will deny,
that the whole system is its own best refutation, not only, but that its
provisions are enforced with such culpable laxity, as to convince every
reflecting mind, that for all the purposes of a safeguard against the
introduction of yellow fever from distant places, it is a sheer nul-
lity.

But let the contagionists and importers make out their case. What
will it amount to ? Is yellow fever an awfully contagious disease ? Is
the body of one man, sick and dying of this fever, competent to the ino-
culation of a whole city ; and do coffee bags and mahogany logs brought
from the West Indies, possess the same power ? Can this very conta-
gious fever be conveyed in persons and things on ship-board, across the
ocean for several thousand miles, so as to endanger the whole commu-
nity of Philadelphia ? Why then have not the protracted tragedies of
1793, 1794, 1795 and 1798, been reproduced in the city of Philadel-
phia, even once during more than twenty years ? With the facts of his-

7*20 The New Orleans Medical and Surgical Journal.

tory staring them full in the face, the most rabid contagionists in the
world must remain dumb, or honestly and candidly recant. To my
mind, it is infinitely more easy to solve the ancient problem of the phi-
losopher's stone, than for the contagionists and importers to meet our
quere on their own principles.

Is it possible for those who believe in the domestic origin and non-
contagion of yellow fever, to do in this regard, what the contagionists
and importers are impotent to accomplish? Can we rationally account
for the non-appearance of this disease as an epidemic in Philadelphia*
for more than twenty years, on the basis which all contagionists utterly
repudiate ?

Let us look into this matter. We have seen that yellow fever has
been unusually fatal, and on a broader scale than heretofore, within a
few year's past, in places with which Philadelphia maintains a constant
and growing intercourse ; and that notwithstanding these known facts,
the disease has failed to desolate the city for so many years, that two
thirds of all her physicians have never seen a case. We think we have
a clear right to the inference, from these premises, that yellow fever
not only has not been imported for the last twenty years, but that it
cannot be, and by consequence, that its alleged contagious attribute
falls to the ground.

Why then has yellow fever ceased to desolate Philadelphia ? And
here our reliance must be on historic facts. What these amount to, we
shall now endeavor to set forth, as concisely as may be, not doubting
that the developments to be made will be satisfactory. And, while we
say satisfactory, we by no means intend to be understood as speaking
of some who will not be convinced by any amount of evidence. It
falls not within the range of our plan to enlighten any who will not
see.

The historic facts to which reference has been made are, 1st. The
unwholesome quality of the pump water, and its abandonment. 2d.
The enaction of rigid laws for insuring cleanliness. 3d. The renova-
ted condition of the river front, and the speedy removal of all nuisances.
All these schemes for promoting the healthfullness were strictly local,
and aimed, not at keeping a foreign fever in its own hotbed, but in
purifying home, and rendering it safe, and even salutary.

In volume 2d, page 457, of Watson's Annals of Philadelphia, we
read thus : There was little or no desire expressed by the citizens of
Philadelphia for any other than good pump water, till after the yellow
fever of 1793. Then, when the mind was alive to every suggested

Dr. Mitchell on Yellow Fever.

721

danger of ill health, the idea of pump water being no longer good,
found its increasing supporters."

In the same work it is stated, " that the first erection of the Phila-
delphia Waterworks took place in 1799."

There are many persons who do not know, that in the early settle-
ment of Philadelphia, it was generally supposed that the city would
never go westward beyond Fifth street. The Governor's mansion,
Christ Church, the first Presbyterian, and the first Baptist church pre-
mises, were located within two or three squares of the river bank,
and the city was as compact a mass of edifices, east of Fifth street,
as the area would permit, with a very few exceptions, as early as
1799. The wells had been dug and pumps placed in them, without
reference to the encroachment of habitations for the emigrants ; and
although the water was at first very pure, yet the rapid multiplication of
privies, which the laws required to be sunk to a specified depth, gra-
dually tainted nearly all the wells, so as to disgust new comers ex-
ceedingly. Well do I remember the time, in my boyhood, when, after
a Saturday afternoon ramble to the Schuylkill, we regaled ourselves at
the old brick-kiln pump, as it was called, on Cedar street, near the pre-
sent Broad street. It was really a treat to men as well as lads, to
drink of that pure water ; for there were not more than one or two
wells beside where the water was really good.

Now if it be borne in mind, that the water tainted by percolation
from a thousand or more privies, constituted the daily drink of the po-
pulation, as a beverage not only, but that vast quantities were constantly
consumed in various dietetic processes, it will not be deemed strange
that Philadelphians, even in 1793, when their number did not exceed
50,000, began to talk freely of schemes for the supply of pure water.

The water-works of 1799 met the difficulty adverted to, and gave
to the city the pure water of the Schuylkill, uncontaminated with fac-
tories, whose refuse and sickly drains have, in more modern times, les-
sened its salubrious qualities. Such was the change in point of purity,
that although tepid in the summer, the Schuylkill water was almost
universally preferred to the very cold issues from the old pumps. And
the expedient proving, as it did, highly satisfactory in kind, the way was
prepared for the mammoth establishment now everywhere known as
the Fairmount Waterworks ; and during the last fifteen years, not a
well in the city has been resorted to, as a means for the gratification of
thirst.

Nor was this mighty water revolution restricted to internal use. The

722

The New-Orleans Medical and Surgical Journal.

water, carried into almost every dwelling, and ready to gush out from
hundreds of fire-plugs on the streets, not only secured against fire, but
gave to the people such an engine for universal cleanliness as Phila-
delphia never realized before. The market-places, hitherto insupport-
ably filthy, became, under the new regime, fit specimens of the cleanly
and wholesome ; and now, twice a week during the summer, are their
pavements deluged with the Schuylkill water. The same facility for
cleanliness is seen by the stranger in all parts of the city, during the
months of the hot season, in the flooding of the gutters to such an ex-
tent, as to wash away every sort of accumulated filth.

The medical reader of facts, setting forth the renovated health of
whole families and communities, merely by a total and perpetual change
of water, in other countries, will be at no loss to appreciate fully the
vast benefits resulting to the entire population of Philadelphia,by the dis-
use of filthy and noxious well water, and the substitution of the limpid
stream in its stead. And if there had been no other improvements in
the city, calculated to insure its healthfulness, this alone might have
been relied on by all future writers, as the grand instrumentality in
saving the city from epidemic yellow fever, which has never found place
in Philadelphia, since the universal introduction of the Schuylkill
water.

Our second item, viz., the enaction of laws for securing general
cleanliness in the city, merits a passing notice. For, apart from the
constant washing of markets and gutters with river water, the laws
forbade the old custom of throwing offal vegetable and animal matters
into the streets ; and carts were to be seen, as now, in every street
daily, ready to take away the refuse matters, placed in buckets or bar-
rels on the footway for that purpose. The privies were put under a
rigid police system, so that by emptying in the winter season, and by
the addition of quicklime in the spring, their tendency to contaminate
the air is almost nullified. These matters are not so many dead let-
ters on the statute book, but are the subjects of a constant and vigi-
lant espionage.

But inasmuch as the river front (we mean on the Delaware) was by
far the most filthy and offensive portion of the city, presenting unsightly
holes for the breaking down of drays and carts, as well as most nox-
ious heaps of all sorts of decomposable matters, left for weeks to pu-
trify and send forth their sickly exhalations, it is quite important to
mark the revolution there. The boy who left Philadelphia for Europe
in 1800, and who should come back in 1853, to survey Water street

Dr. Mitchell on Yellow Fever.

723

and the alleys leading thence to the river, and the entire river front of
several miles in length, would find himself in a new region, and might
well begin to conjecture that he was in the wrong place. In lieu
of mud streets, abounding in vast gullies and indescribable filth, the
whole region presents a firm and uniform stone pavement, with brick
sidewalks, wharves kept in the best possible condition, and the lodg-
ment of filth made indictable, as a common nuisance.

In view of these local improvements, in the city of Philadelphia,
after the year 1799, let me inquire, whether expedients very much of
the same nature, have not eradicated the endemic character of many
localities on our great Western rivers ? Why have merely nomi-
nal villages, once containing not more than a dozen dwellings, and
scarcely inhabitable by reason of periodical fevers, grown to 'be
quite large towns, ranging between one and three thousand inhabit-
ants, who enjoy as good a share of health as the people of older cities ?
The answer is at hand, for I have witnessed the revolution, and can
therefore speak of it confidently. The holes, ravines and dykes have
been filled, so as to present a gradual, even slope upward from the river
bank. All the sources of fowl exhalations have been and are care-
fully removed, and where the swell of the Mississippi formerly made
its mark for days and weeks, large store houses and dwellings of good
structure are to be seen. The hand of industry and thrift has been
there, and the place is no longer the hot-bed of agues and fevers. And
just so has it been with the now great, but once small city of Philadel-
phia. The sources of its former epidemic desolations have been anni-
hilated. The sequel has been told already.

The entire controversy about importation and contagion of yellow
fever, so far as Philadelphia is a part of that controversy, can be com-
pressed within the circumference of a nut-shell thus :

1st. Yellow fever has been a most desolating scourge in former
years, to the city of Philadelphia.

2d. The population and commerce of the city have been vastly in-
creased during the last quarter of a century ; and yellow fever is the
same terrible scourge in places to which our vessels constantly trade,
as it ever was.

3d. As an epidemic, or in any other way to excite alarm and terror,
this disease has been so entirely absent from Philadelphia for more
than twenty years, that not one in one hundred of all her vast army of
physicians has ever seen a case, within its geographical limits.

724

The New -Orleans Medical and Surgical Journal.

4th. Yellow fever has not been imported into Philadelphia for a pe-
riod not exceeding twenty years, and the fair inference from this fact is>
that it cannot be, and that it never was imported. And as importation
and contagion are inseparable as the Siamese twins, if one be annihi-
lated, the extinction of the other necessarily follows.

III.— COOPER'S WELL WATER— ITS MEDICINAL VIRTUES IN CER-
TAIN FORMS OF DISEASE.

BY J. T. KENNON, M. D.., OF MISS.

A. Hester, M. D.

Dear Sir — A few remarks in relation to this justly celebrated wa-
tering place, may be perused with some degree of interest by many of
your readers. And the object I have in view in making this communi-
cation is, to bring before the profession a few facts connected with the
medicinal properties of this water, as they occurred under my immedi-
ate observation during the past year.

By reference to my case book, I find recorded forty-six cases of diarr-
hoea. A very large majority of these cases were relieved, many per-
fectly cured, and quite a number did not remain a sufficient length of
time for the water to manifest its full powers. I believe that nineteen
cases out of twenty, suffering from chronic diarrhoea, would recover
here, with a little medical aid, and a proper exercise of prudence, by
the judicious use of this water.

Of fifty-one cases of dyspepsia, the major part were relieved. Here
again many of the patients left without giving the water a fair trial. I
have observed, that the virtue of this water is not so prompt in its ac-
tion, generally, in dyspepsia as it is in diarrhoea. This may be owing
to the greater complications, in most instances, of dyspepsia.

Seven cases of simple indigestion were perfectly relieved in a very
short time.

In most of the chronic affections of the liver, this water acts very
finely. When that organ is in a torpid state, an increased flow of bile*
and a more healthy action, invariably follows its use. I remember two
cases, where there were very evident symptoms of shrinking and soft-
ening of the liver, in which there was no decided benefit derived.

Twenty-four cases of general debility, from the ordinary fevers of our
country, and from dysentery, recovered very rapidly. One patient, who

Dr. Kennon on Cooper's Well Water.

725

had suffered from a severe and protracted attack of typhoid fever, that
had left him partially paralyzed, gained, in sixteen days, twenty-four
pounds of flesh, and strength in proportion.

In chronic dysentery, after all the inflammatory symptoms have sub-
sided, it exerts a beneficial influence ; but aggravates acute cases.

In diseases of the womb, owing to its tonic and alterative properties,
this water displays its virtues in an eminent degree, especially in sup-
pression and irregularity of the catamenia. During the past summer
I treated a case of malignant ulceration of the neck of the womb, ac-
companied with diarrhoea and great prostration ; cured in six weeks.
Also a case of extensive ulceration of the vagina and womb, cured in
five weeks.

In most of the affections of the womb, bladder and kidneys, it will
seldom disappoint the most sanguine expectations. In three cases of
diabetes, one was perfectly cured, and the other two very much im-
proved.

Wherever disease has been confined to the mucous membrane, I
have never known it to fail in producing a salutary effect. It has cured
several severe cases of bronchitis ; but in consumption, the most disas-
trous results invariably follow its use. Three cases of consumption
were brought here during the last season, and two of them died on the
seventh and the other on the tenth day after they arrived. It is very
injurious in functional and organic diseases of the heart.

In dropsy, where the powers of the system are not so much prostrated,
as to prevent the free use of the water, it is nearly a certain remedy.
In cases of sick headache, the suffering ones are never disappointed
who seek for relief at this fountain.

In constipation it stands unrivalled. During the last season a case
of fifteen years duration, who, like the woman mentioned in the Scrip-
tures, " had suffered many things of many physicians, and was nothing
bettered, but rather grew worse," was perfectly relieved in six weeks.

In nervous debility, secondary syphilis, gleet, gonorrhoea, etc., the
effects are decidedly beneficial.

Two cases of chronic rheumatism were very much improved; but it
is entirely too exciting in acute cases.

In most of the eruptive diseases of the skin it acts finely. I had two
cases of tympanitis, but they remained so short a time, it was impossi-
ble for me to determine whether they derived benefit or not. Also two
cases of spasmodic contraction of the lower portion of the aesophaguse

726

The New-Orleans Medical and Surgical Journal*

These patients remained but a few weeks, during which time their
general health was somewhat improved* To one of them I adminis-
tered strychnine with decided good effect.

I have never seen this water fairly tested in scrofula, but entertain
the opinion that it would make a good adjunct in the treatment of thafe
disease.

The predominant properties of this water are tonic, powerfully dia-
phoretic and diuretic, apperient, and when taken freely, actively cathar-
tic, slightly stimulant, often producing a sensation of fulness about the
brain, and an exhilerating influence upon the mind. The effects upon
the brain are very similar to those that follow the drinking of a few
glasses of Champagne wine.

This highly medicated water has made some very astonishing cures,
and it yet remains to be discovered, the vast extent of its application
and adaptation to the various forms of human maladies. Many are the
living witnesses, who stand up in the pride of health to testify to its effi-
cacious powers-- who, when hope had almost fled them, and life's flame
was flickering low in the socket—- when the physician had given them
up, and friends despaired of their recovery, came and drank, and live to
tell this wondrous story. And among the important cures that have
been made here, are several distinguished members of the profession ;
and I will take the liberty of mentioning the names of Doctors Sims and
Foster of Alabama, and Dr. Boswell of Georgia.

The following analysis of these waters, by Dr. Lawrence Smithy
will exhibit in a comprehensive form their peculiar characteristics :

Temperature — 64 ° Fahr., the air being at 50 ° .
Taste — Not unpleasant, and slightly mineral.

Odor — Little or none, although it is said most commonly to have a marked odor of
sulphuretted hydrogen ; the quantity however must be very small.
Color — Transparent, with small yellow flakes floating on it.
Specific Gravity — 1.00147.
Gas contained in one wine gallon.

Cubic inches — Oxygen. 1.5
do. do. Nitrogen 4.5
do. do. Carbonic Acid 4.0

. Br. Nott on the Geographical Distr ibution of Animals. 727

SiKd contents of one gallon are 105 grains, composed as follows :

Grains.

Sulphate of Soda, 11.705

Sulphate of Magnesia, 23J28®

Sulphate of Lime, 42.122

Sulphate of Potash, 0.608

Sulphate of Alumina, 6.120

Chloride of Sodium 8.360

Chloride of Calcium, 4.322

Chloride of Magnesium, 3.480

Peroxide of Iron, 3*362

Crenate of Lime, 0.3 1 1

Silicla, 1-801

105,471

The deposit which collects in concentrating the water, contains in 100 grains-

Grains*

Water, 38
Crenate of Lime, 2
Sulphate of Lime, 25
Peroxide of Iron, 35

The iron in the water was found altogether in the yellow part which floats about,
although it is more than probable that at certain seasons of the year it must also fee
found in the clear water.

Feb., tlst, 1852.

IV.— GEOGRAPHICAL DISTRIBUTION OF ANIMALS AND THE
RACES OF MEN.

BY J. C. NOTT, M. D., OF ALA.

Have all the living creatures of our globe been created at one com-
mon point in Asia, and from thence been disseminated over its wide
surface by degrees, and adapted to the varied conditions in which they
have been found in historical times ; or, on the other hand, have differ-
ent genera and species been created at points far distant from each other,
with organizations suited to the circumstances in which they were ori-
ginally placed ?

Two schools have long existed, diametrically opposed to each other,
on this question. The first may be termed the Theological Naturalists,
who now look to the Book of Genesis, or what they conceive to be the
inspired word of God, as a text book, of Natural History, as they for-
merly did of Astronomy and Geology. The second, embraces the Na-
turalists proper, whose conclusions are derived from facts, and the laws
of God as revealed in his works, which are immutable.

Not only the authority of Genesis in matters of science, but the au-
thenticity of this book is now questioned by a very large proportion oi

728 The New- Orleans Medical and Surgical Journal.

the most authoritative theologians of the present day ; and as its lan-
guage is clearly opposed to many of the well-established facts of modern
science, we shall unhesitatingly take the benefit of this liberal con-
struction. The language of Genesis touching the point now before us
is so unequivocal, and so often repeated, as to leave no doubt as to the
author's meaning. It teaches clearly that the Deluge was universal,
that every living creature on the face of the earth at the time was de.
stroyed, and that seeds of all the organized beings of after times were
saved in Noah's Ark. The following is but a small portion of its oft-
repeated language on this point.

" And the waters prevailed exceedingly upon the earth, and all the high hills that
were under the whole heaven, were covered." "Fifteen cubits upward did the waters
prevail and the mountains were covered," " And all flesh died that moved upon the
earth, both of fowl, and of cattle, and of beast, and every creeping thing that creep-
eth upon the earth, and every man. All in whose nostrils was the breath of life, of all
that was in the dry land — and Noah only remained alive, and they that were with
him in the Ark." Gen. Chap.vii.

Now we repeat that language cannot be more explicit than this, and
if it be true, it must apply with equal force to all living creatures —
animals as well as mankind. It is really trifling with language to say,
that it does not distinctly convey the idea, that all the creatures of our
day have descended from the seed saved in the Ark, that they were
created within a certain area around the point at which Adam and Eve
are supposed first to have had their being.

Though the same general laws prevail throughout the entire Fauna
and Flora of the globe, yet in' the illustration of our subject, we must
restrict our remarks mainly to the class of Mammifers, as a wider range
would lead beyond our prescribed limits.

It has been a widely received error, from time immemorial, that de.
grees of latitude, or in other words, temperature of countries, was to be
regarded as a sure index of the color, and certain other physical char,
acters of races of men. This opinion has been supported by many
able writers of the present century, and even in the last few years by
no less authority than that of the distinguished Dr. Prichard, in his
"Physical History of Mankind;" a rapid change, however, is now
going on in the public mind on this point, and so conclusive is the recent
evidence drawn from the monuments of Egypt and other sources, in
support of the permanency of the well marked types of mankind, as the
Egyptians, Jews, Negroes, Mongols, American Indians, etc., that we
presume no really well informed naturalist will again be found advocat-

Dr, Nott on the Geographical Distribution of Animals, 729

ing such notions. In fact, it is difficult to conceive how any one, with
the facts before him, recorded by Prichard himself, in connection with
an Ethnographical Map, should believe that climate could account for
the endless diversity of races seen scattered over the earth from the
earliest dawn of history.

It is true that most of he black races are found in Africa ; but on the
other hand, many equally black are found in the temperate climates of
Australia and Oceanica, though differing in every thing except color. A
black skin would seem to be the best suited to hot climates, and for this
reason we may suppose that a special creation of black races is found
in Africa. The strictly white races are found in the Temperate Zone,
where they flourish best, and they certainly deteriorate physically, it
not intellectually, when removed to hot climates. Their type is not in
reality changed or obliterated, but they undergo a degradation from
their primitive one, analogous to the operation of disease. The dark-
skinned Hyperboreans are found in the Frigid Zone, which is most con-
genial to their nature, and from which they cannot be enticed by more
temperate climes. The Mongols of Asia, and the Aborigines of Ame-
rica, with their peculiar types, are spread over almost all degrees of lati-
tude.

So is it with the whole range of Mammifers, as well as birds, etc*
The lightest and darkest colors — the most gorgeous and most sombre
plumages are everywhere found beside each other, though brilliant
plumages and colors are more common in the tropics, where men are
generally more or less dark.

Every point on the earth's surface, from Pole to Pole — the mountains
and valleys — the dry land and the water, has its organized beings,
which find around a given centre all the conditions necessary for their
preservation. These living beings are as innumerable as the condi-
tions of the places they inhabit, and their different stations are as va-
ried as their instincts and habits. To consider these stations, under the
simple point of view of the distribution of heat on their surface, is ab.
solutely to see but one of the many secondary causes of nature which
influence organized beings.

Amidst the infinitude of beings spread over the globe, the Class of
Marnmifers stands first in organization, and at its head Zoologists have
placed the Bimanes (Mankind). It is the least numerous, and its gen-
era and species are almost entirely known.

This class is composed of about 200 genera, which may be divided
into two parts. 1st. Those whose habitations are limited to a single

730 The New-Orleans Medical and Surgical Journal.

!Zone. 2d. Those, on the contrary, which are scattered through all
the Zones. There would seem at first a striking contrast between
these two divisions ; on the one side, complete immobility, and on the
other, great mobility ; but this irregularity is only apparent, for when
we examine attentively the different genera, we find them governed by
the same laws. Those of the first division, whose habitation is limited,
are in general confined to a few species ; while those of the second, on
the contrary, contain many species, but which are themselves confined
to certain localities, in the same manner as the small genera of the
first division. Thus we find the same law governing species in both
instances. We will cite a single example out of many. The White
Bear is confined to the Polar regions, while other species inhabit the
temperate climates of the mountain chains of Europe and America; and
finally, the Malay Bear, and the Bear of Borneo, are limited to torrid
climates.

We may then consider the different species of Mammifers as ranged
under the same law of geographical distribution, and say that each
species on the globe has its limited space, beyond which it does not
extend ; and that every country on the globe, whatever may be its tem-
perature, its analogies, or differences of climate, possesses its Mammi-
fers, different from those of other countries, and which belong to it
alone. There are apparent exceptions to this law, but they are all sus-
ceptible of explanation.*

A few species are really common to the two continents, but only in
the Arctic region. The two continents are there united by icy plains,
which may be easily traverser! by certain animals, and the White Bear,
the Wolf, the Red Fox, the Glutton, are common to both, but the conti-
nents and climates may here be really considered as one. We shall
show, as we go on, that with a few exceptions in the Arctic region,
the Faunae and Florse of the two continents, are entirely distinct, and
that even the Temperate Zones of North and South America do not
present the same types, although they are separated only by table lands
which present none of the extremes of climate seen in the Tropic of
Africa.

But this immobility imposed by nature on its creatures, is illustrated

* Considerations Generates sur 1' Anthropologic, etc. Par M. Honore Jacquinot.
Paris. 1846.

This is one of the most remarkable books of our day, and we beg leave once for
all to say, that we have drawn freely on it throughout this chapter, as well as some
others.

Dr. Nott on the Geographical Distribution of Animals. 721

in a still more striking manner if we turn to the Mammifers which in-
habit the ocean, where there are no appreciable impediments, none of
those infinitely varied conditions, which are seen upon the land, even
in the same parallels of latitude. The temperature of the ocean va-
ries almost insensibly with degrees of latitude, and among the immense
crowd of animals which inhabit it, we find numerous families of Mam-
mifers, Though endowed with great powers of locomotion, and not-
withstanding the trifling obstacles opposed to them, like animals of the
land, they are limited to certain localities. The genera Calocephal'est
Stemmatopes and Morse, are peculiar to the Northern Seas. In the
South, on the contrary, we find the genera Otarie, Stenorynque, Platy-
rynque, etc. Other species inhabit only hot or temperate regions.

The numerous species of Whales and Dolphins, with their prodigi-
ous powers of locomotion, are confined each to regions assigned them.
While there is so little difference of temperature in the ocean, that a
human being might, on a summer's day, swim with delight from the
North Temperate Zone to Cape Horn off any coast of America, there
is no degree of latitude in which we do not find species peculiar
to it.

After a resume of these and numerous kindred facts, M. Jacquinot
uses the following emphatic language : " To recapitulate, it seems to us,
after all we have said, that we may draw the following conclusions, viz.,
that, all the Mammifers on the globe have a habitation limited, and cir-
cumscribed, which they never overleap ; their reunion contributes to
give each country its particular stamp of creation. What a contrast
between the Mammifers of the Old and New World, and the creations
so special and so singular of New Holland and Madagascar."
Facts thus point to numerous centres of creation, where we find crea*
tures fixed, with peculiar temperaments and organizations, which are in
unison with surrounding circumstances, and where all their natural wants
are supplied. But the strongest barrier would seem to be that of instinct
— that force blind and incomprehensible, which binds them to the soil
which has seen their birth.

Let us now turn t,o the races of Mankind and their geographical dis-
tribution, and see whether they form an exception to the laws which
have been established for the other orders of Mammifers. Does not
the same physical adaptation, the same instinct, which binds animals to
their primitive localities, bind the 'races of Men also ? Those races
which inhabit the Temperate Zones, as the white races of Europe,
for example, have a certain degree of pliability, which enables them

732 The New -Orleans Medical and Surgical Journal,

to bear climates to a certain extent hotter or colder than their native
one, but still there is a limit beyond which they cannot go with impu-
nity— they cannot live in the Arctic with the Esquimaux, or in the Tro-
pic of Africa with ihe Negroes. The Negro, too, (as have the Ele.
phant, the Lion, the Camel, etc.,) has a certain pliability of constitu-
tion, which enables him to enter the Temperate Zone, but his North-
ern limit stops far short of that of the natives of this Zone. The high
caste, of what are termed Caucasian races, are influenced by several
causes in a greater degree than other races. To them have been as-
signed, in all ages, the largest brains and the most powerful intellects;
theirs is the mission of extending and perfecting civilization — they are
by nature ambitious, daring, domineering and reckless of danger —
impelled by an irresistable instinct, they go to all climes, regardless
of difficulties, and how many thousands are sacrificed annually to cli-
mates foreign to their natures.

It should be borne in mind too, that what we term the Caucasian
race, is not a unit ; it is, on the contrary, an amalgamation of an infin-
ite number of primitive stocks, of different instincts, temperaments,
mental and physical characters, etc. Egyptians, Jews, Arabs, Teu-
tons, Celts, Slavonians, Pelasgians, Romans, Iberians, etc, etc.,
are all mingled in blood, and it is impossible now to go back and unra-
vel this heterogeneous mass, and say precisely what each originally
was. This mingling of blood, through migrations, wars, captivities
and amalgamations, is doubtless one of the means by which Providence
carries out his great ends. This mixed stock is the only one which
can really be considered cosmopolite. The infinite diversity of charac-
ter and instincts which belongs to them, contrasts strongly with the
characters of other families.

How stands the case with those races which have been less sub-
jected to disturbing causes, and whose moral and intellectual structure
is less complex. The Greenlander in his icy region, amidst poverty,
hardship and want, clings with instinctive pertinacity to his birth-place,
in spite of all — the Temperate Zone, with its luxuries, has no charm
for him. The African of the Tropic, the Aborigines of America, the
Mongols of Asia, the inhabitants of Polynesia, have remained for thou-
sands of years where history found them, and nothing but absolute
want, or self-preservation, can drive them from the countries where the
Creator placed them. These races have been least adulterated, and
have better preserved their original instincts and love of home. This
is illustrated in a most remarkable degree by the Indians of America—

Dr. Nott on the Geographical Distribution of Animals. 733

we still see the small remnants of scattered tribes fighting and dying
to preserve the lands of their ancestors.

We shall have more to say, in another chapter, on the amalgamation
of races ; but we may here remark, that the infusion of even a small
proportion of the blood of one race into another, produces the most de-
cided modification of moral and physical characters. A small trace of
white blood in the negro improves his intelligence and moral character;
and a small trace of negro blood, as in the quartroon, will protect the
individual against the deadly influence of climates, which the pure white
man cannot endure. For example, if the population of New England,
Germany, France, England, etc., come to Mobile, or New Orleans, a
large proportion die with yellow fever, and of one hundred such individ-
uals landed in New Orleans, at the commencement of an epidemic of
yellow fever, probably half would fall victims to it. On the contrary,
negroes, under all circumstances, enjoy an almost perfect exemption
from this disease, though brought in from our Northern States ; and
what is still more remarkable, the mulattoes (under which term we
include all mixed grades) are almost equally exempt. I have seen
many hundred deaths from yellow fever, but never more than three or
four mulattoes, though we have hundreds exposed to it in Mobile.
This is a curious fact, and shows how difficult is the problem of amal-
gamation.

Negroes die and would become extinct in New England, if cut off
from immigration, as is clearly shown by published statistics.

It may be even a question whether the strictly white races of Eu-
rope are perfectly adapted to any climate in America. We nowhere
find in the United States a population physically equal to that of Great
Britain or Germany, and we recollect once hearing this remark strongly
endorsed by Mr. Clay, though living amidst the best population of this
country. Knox, in his work on Races, says that the Anglo-Saxon race
would become extinct in America, if cut off from immigration. Now
we are not prepared to endorse this assertion, but as nature works not
only through a few generations, but through thousands of years, it is
impossible to conjecture what time may do. It would be a curious en-
quiry to investigate the causes which have led to the destruction of
ancient empires, and the disappearance of populations, as Egypt, As-
syria, Greece, Rome, etc. Many ancient nations were colonies from
distant climes, and may have wasted away under the operation of laws
which have acted slowly and surely. The mingling of different bloods,
too, under the law of hybrid ity, may also have played an important
part, Mr. Layard tells us that a few wandering tribes only are now

734 The New-Orleans Medical and Surgical Journal.

seen around the sites of the once mighty Nineveh and Babylon, and
that no one can now say what race constructed those stupendous cities*
But let us return from this digression.

To this instinctive love of primitive locality, and instinctive dislike
to other lands, and other people, must we mainly attribute the fixedness
of the unhistoric types of men. The greater portion of the globe is
still under the influence of this law. In America, the Aboriginal bar-
barous tribes cannot be persuaded or forced to change their habits, or
to successful emigration ; they are melting away from year to year,
and of the millions which once inhabited that portion of the United
States east of the Mississippi river, all are gone but a few scattered
families, and their representatives who have been removed by our Go-
vernment to the Western frontier, are reduced to less than one hun-
dred thousand ; and it is as clear as the sun at noon-day, that in a few
generations more the last of these Red men will be numbered with
the dead. We are constantly reading glowing accounts from mission-
aries, of the civilization of these tribes, but a civilized full-blooded In-
dian does not exist among them We see every day in the sub-
urbs of Mobile, and wandering through our streets, the remnant of the
Choctaw race, covered with nothing but blankets, and living in bark
tents, scarcely a degree advanced above the brutes of the fields, quietly
abiding their time — no human ingenuity can induce one to be educated,
or to do an honest day's work ; they are supported entirely by begging,
and a little traffic of the squaws in wood. To one who has lived among
the American Indians, it is in vain to talk of civilizing them. You
might as well attempt to change the nature of the Buffalo.

The whole continent of America, with its mountain ranges and table
lands — its valleys and low plains — its woods and prairies — presenting
every variety of climate which could influence the nature of man, is
inhabited by one great family that presents a prevailing type. Small
and peculiar shaped crania,a cinnamon complexion, small feet and hands,
black straight hair, wild, savage natures, etc., characterize them every-
where. There are a few trivial exceptions, which may be accounted
for, particularly on the Pacific coast.

The eastern part of Asia presents a parallel case. From 65 degrees
north latitude to the Equator, it presents the greatest inequalities of
surface and climate, and is peopled throughout by the yellow, lank-haired
Mongols, the darkest being at the North and the fairest at the South.
Their crania, their instincts, their whole moral and physical char-

Dr. Nott on the Geographical Distribution of Animals. 735

acter distinguishes them from the American race, which they most
resemble.

The other half of this northern continent, that is to say Europe and
the rest of Asia, may be divided into a northern and a southern division.
The first extends from the Polar region to the 45th or 50th degree north,
from Scandinavia to the Caspian Sea, and contains a group of men with
light hair, complexion fair and rosy, and blue eyes. The second or
southern division, running north-west and south-east, extends from the
British Isles to Bengal, and the extremity of Hindostan, from the 50th
degree to 8 or 10 degrees north. This vast area is covered by people
with complexions more or less dark, oval faces, black smooth hair, and
black eyes.

Now it is worthy of remark, that since the discovery of America,
several centuries, the fair races have inhabited North America exten-
sively, while the dark races, as the Spaniards, have inhabited South
America, Mexico and Central America ; both have displaced the Abo-
riginal races, and yet have made no approximation in type to the latter,
nor does any one suppose that they would in a hundred generations.
And so with the Negroes who have lived here through eight or ten gen-
erations. We have no more reason to suppose that an Anglo-Saxon
will turn to an Indian, than imported cattle to Buffaloes. We shall
show in another chapter, that the oldest Indian crania from the Mounds,
some of which are probably several thousand years old, bear no resem-
blance to those of any race of the old continent.

When we come to Africa, we shall see various races of peculiar types
occupying .their appropriate zoological provinces, which they have in-
habited for at least 5000 years. But we have to develop some new
views respecting Egypt in another place, when we shall take up the
races of this continent in extenso.

Taking our leave for the present of continents, let us glance for a
moment at New Holland. This immense country, extending from lati.
tude 10 degrees to 40 degrees South, has a special creation — its popu-
lation, its animals, birds, insects, plants, etc., are entirely unlike those
found in any other part of the world. The men present altogether a
very peculiar type — they are black, but without the features, woolly
heads, or other physical characters of the negroes. Beyond, we have
Van Dieman's Land, extending to 44 degrees of South latitude, which
presents a temperate climate not unlike that of France ; and what is

736

The New-Orleans Medical and Surgical Journal.

remarkable, its inhabitants, unlike those of New Holland, are black,
with frizzled heads, and very like the African races.

Not far from New Holland, under the same parallels, and extending
even farther South, we find New Zealand, where commences the beau-
tiful Polynesian race, of light brown color, smooth black hair, and al-
most oval face. This race extends from 50 degrees South, descends to
the Equator, then mounts to the Sandwich Islands, to 20 degrees North,
scattered over islands without number, encircling almost half the globe,
without presenting any material difference in their color, forms — in a
word, in their zoological characters.

India affords a striking illustration of the fallacy of arguments drawn
from climate. We there find people of all shades, from fair to black,
who have been living together from time immemorial. We have the
well known testimony of Bishop Heber and others, on this point ; and
Desmoulins says, " The Rohillas, who are blonds, and situated South
of the Ganges, are surrounded by the Nepauliens with black skins —
the Mahrattas with yellow skins — and the Bengales of a deep brown
— and yet the Rohillas inhabit the plain, and the Nepauliens the moun-
tains."* Here we have either different races inhabiting the same cli-
mate for several thousand years without change ; or the same race as-
suming every shade of color. The advocates of unity may choose either
horn of the dilemma.

We might thus go on and recite innumerable facts to the same ef-
fect, but it would be superfluous.

The different shades of color in races, have been regarded by many
naturalists as one of their most distinctive characters, and have served
as the basis of numerous classifications ; but M. Jacquinot thinks too
much importance has been attached to them, and that they cannot be
relied upon. For example, all the intermediate shades, from white to
black, are found in those races of oval face, large facial angle, smooth
hair, etc., which Blumenbach has classed under the head Caucasian,
Commence, for example, with the fair Fins and Slavonians with blond
hair, and pass successively through the Celts, Iberians, Italians, Greeks,
Arabs, Egyptians, and Hindoos, till you reach the inhabitants of Mal-
abar, who are as black as negroes.

Among the Mongols, too, we find various shades. Among the Afri-
cans there exist all the tints from the pale yellow Hottentots, Bushmen
and Cafirs, to the coal-black negro of the Tropic and confines of

* Des Races Humaines. P. 169.

Dr. Nott on the Geographical Distribution of Animals. 737

Egypt. In a word, the black color is found in Caucasians, Negroes,
Mongols, Australians, etc., while the yellow or brown is seen through
all the above types, as well as in the Americans, Malays and Poly-
nesians.*

In the present mixed state of the population of the earth, it is per-
haps impossible to determine how far this opinion of Jacquinot is cor-
rect. We have certainly many examples to prove that color has been
permanent for ages; while, on the contrary, it is impossible to prove
that the complexion of a pure primitive stock has been changed by
climate. As before stated, we conceive that too much importance has
been given to arbitrary classifications, and that the Caucasian division
may include innumerable primitive stocks. This we have illustrated
particularly in the history of the Jews, whose type has been permanent
for at least 3000 years. We have no reason to believe that this race
sprang from, or ever originated, any other.

We therefore not only regard the great divisions of Caucasian, Mon-
gol, Malay. Negro and Indian, as primitive stocks, but History, Anat-
omy, Physiology, Phsychology, Analogy, all prove that each of these
comprehend many original subdivisions.

We here beg leave to acknowledge our large indebtedness to Mr.
Agassiz, who has given the most masterly view of the geographical
distribution of animals to be found in our language, or perhaps any
other. Not a line can be retrenched from his condensed articles,")" with-
out inflicting a wound, and we take much pleasure in referring the
reader to them. He shows, conclusively, that there are not only nu-
merous centres of creation, or zoological provinces, for our geological
epoch, but that these provinces correspond, in a surprising manner,
with those of former epochs; thus showing that the Creator has been
working after one grand and uniform plan through myriads of years,
and through successive creations. He says : " It is satisfactorily as-
certained at present, that there have been many distinct successive pe-
riods, during each of which large numbers of animals and plants have
been introduced upon the surface of our globe, to live and multiply for a
time, then to disappear and be replaced by other kinds. Of such dis-
tinct periods — such successive creations — we know now at least about
a dozen, and there are ample indications that the inhabitants of our

* Jacquinot — Op. Cit.

f See Christian Examiner.

738 The New-Orleans Medical and Surgical Journal.

globe have been successively changed at more epochs than are yet fully
ascertained."

In the earliest formations, but few and distant points of land had
emerged from the mighty deep, the created beings were comparatively
few, simple, and more widely disseminated, but yet we find many dis-
tinct species, adapted to localities where they were brought into exist-
ence. In the more recent fossil beds, we find a distribution of fossil
remains which agree in a most remarkable manner with the present
geographical arrangement of animals and plants. The fossils of mod-
ern geological periods in New Holland, are the same types as most of
the animals now living there. The fossils of Brazil belong to the same
families as those found there at the present day ; though in both cases
the fossil species are distinct from living ones. If, therefore, the or-
ganized beings of the ancient geological periods had arisen from one
central point of distribution, to be dispersed, and finally to become
confined to those countries where their remains are found in a fos-
sil condition, and if the animals now living had also spread from a
common origin, over the same districts, and had these been circum-
scribed within equally distinct limits, we should be led to the unnatural
supposition, that animals of two distinct creations, differing specifically
throughout, had taken the same lines of migration, had assumed finally
the same distribution, and had become permanent in the same regions
without any other inducement for removal and final settlement, than the
mere necessity of covering more extensive ground, after they had be-
come too numerous to remain any longer together in one and the same
district* (Agassiz.)

Now it would certainly be very unreasonable to attribute such in-
stincts to animals, if such a line of march were possible ; but the very
possibility however vanishes, when we reflect upon the wide-spread
physical impediments which oppose such migrations, and that neither
the animals or plants of one province can be carried to a distant one.
Neither Arctic animals or plants can be propagated in the Tropics, or
vice versa. The whole of the Monkey tribe belong to a hot climate,
are retained there by their temperaments and instincts, and cannot by
any ingenuity of man be made to exist in Greenland. The same rule
applies to the men of the Tropics and Arctic.

That the animals and plants now existing on the earth must be re-
ferred to many widely distant centres of creation, is a fact which might,
if necessary, be confirmed by an infinite number of other facts; but it is
a point which will be conceded by every well-informed naturalist, and

Dr. Nott on the Geographical Distribution of Animals. 739

we have only deemed it necessary to illustrate it at all because this
volume may fall into the hands of some, who, it is presumed, are not
informed on such matters.

Another question of much interest to our present investigation is this.
Have all the individuals of each species of animals, plants, etc., de-
scended from a single pair ? Were it not for the supposed authority
of Genesis to this effect, the idea of community of origin would hardly
have occurred to any reflecting mind, for it involves many insuperable
difficulties ; and we can see no reason why the Creator should have
adopted such a plan. Is it reasonable to suppose that the Almighty
would have created one seed of grass, one acorn, one pair of locusts,
of bees, of wild pigeons, of herrings, of buffaloes, as the only starting
point of these wide-spread species ?

The instincts and habits of animals differ widely. Some are solitary,
except at certain seasons ; some go in pairs ; others in herds or shoals.
The idea of a pair of bees, locusts, herrings, buffaloes, is contrary to
*he nature and habits of these creatures, as it is contrary to the nature
of oaks, pines, birches, etc., to grow singly, and to form forests in their
isolation. In some species males— in others females predominate; and
in many it would be easy to show, that if the present order of things
was reversed, the species could not be preserved— -locusts and bees, for
example ; the former come in myriads, and by far the greater number
of those produced are destroyed ; and though they have been existing
for ages, naturalists cannot see that they have increased, nor can they
conceive that one pair could continue the species, with the number of
chances opposed. For the bees, it is natural to have but one female
for a whole hive, to whom many males are devoted, and a large number
of drones.

Again, Mr. Agassiz gives the following striking illustration: "There
are animals who are impelled by nature to feed on other animals. Was
the first pair of lions to abstain from food until the gazelles and other
antelopes had multiplied sufficiently to preserve their races from the
persecution of these ferocious beasts ?" So with other carnivorous ani-
mals, birds, fishes, etc. We now have all the various species scattered
through the land and water in harmonious proportions, in which they
may continue for ages to come.

Hybridity has been considered a test for species, but when we come
to this point we shall show, that in many instances what have been
called varieties are really distinct species, and that hybridity is no test.
All the varieties of dogs and wolves, for example, are prolific inter sc,

740 The New-Orleans Medical and Surgical Journal.

yet we shall prove that many of them are specifically distinct, or de*
scended from different primitive stocks in distant points of the globe.
Mr. Agassiz has beautifully illustrated this point by the natural history
of lions* These animals present very marked varieties, extending over
an immense region of country. They occupy nearly the whole conti-
nent of Africa, a great part of Southern Asia, and formerly Asia Minor
and Greece. Over this immense extent of country several varieties of
lions are found, differing materially in their physical characters ; they
too are placed at points distant from each other, and surrounded by en-
tirely distinct Faunae and Floras, which goes far towards confirming the
idea of totally distinct zoological provinces. It will readily be conceded
by naturalists, that all the animals found in such a province, and no-
where else, must have been created there, and though the lions may
possess in common that assemblage of characters, which has been con-
sidered as evidence af community of species, yet it by no means neces-
sitates community of origin. The same question here arises as m the
varieties of mankind, with regard to the definition of the term species.
We hold that a variety which is permanent, and which resists without
change all known external causes, must be regarded as a primitive
species — else we have no criteria by which we can be governed on this
point.

The monkeys afford another admirable illustration, and are doubly
interesting from the fact of their near approach to the human family.
The following extract is one of peculiar interest :

4< As already mentioned, the monkeys are entirely tropical. But here again We no-
tice a very intimate adaptation of their types to the particular continents; as the mon-
keys of tropical America constitute a family altogether distinct from the monkeys of
the old world, there being not one species of any of the genera of Quadrumana, so
numerous on this continent, found either in Asia or Africa. The monkeys of the Old
World, again, constitute a natural family by themselves, extending equally over
Africa and Asia ; and there is even a close representative analogy between those of
different parts of these two continents, the orangs of Africa, Chimpanzee and Orilla,
corresponding to the red orang of Sumatra and Borneo, and the smaller long armed
species of continental Asia. And what is not a little remarkable is the fact, that the
black orang occurs upon that continent which is inhabited by the black human
race, while the brown orang inhabits those parts of Asia over which the chocolate
colored Malays have been developed. There is again a peculiar family of Quadru-
mana confined to the Island of Madagascar, the Makis, which are entirely peculiar
to that Island and the eastern coast of Africa oposite to it, and to one spot on the
western shore of Africa. But in New Holland and the adjacent islands there are no
monkeys at all, though the climatic conditions seem not to exclude their existence,
anymore than those of the large Asiatic Islands, upon which such high types of this

Dr. Nott on the Geographical Distribution of Animals. 741

order are found. And these facts more than any other would indicate, that the spe-
cial adaptation of animals to particular districts of the surface of the globe, is neither
accidental nor dependent upon physical conditions, but is implied in the primitive
plan of creation itself. Whatever classes we may take into consideration, we shall
find similar adaptations, and though perhaps the greater uniformity of some families
renders the difference of types in various parts of the world less striking, they are
none the less real. The carnivora of tropical Asia are not the same as those of tro-
pical Africa, or those of tropical America. Their birds and reptiles present similar
differences. The want of an ostrich in Asia, when we have one, the largest of the
family, in Airica, and two distinct species in Southern America, and two cassowaries,
one in New Holland and another in the Sunda Islands, shows this constant process of
analogous or representative species, repeated over different parts of the world, to be the
principle regulating the distribution of animals, and the fact that these analogous spe-
cies are different, again, cannot be reconciled to the idea of common origin, as each
type is peculiar to the country where it is uow found. These differences are more
striking in tropical regions than anywhere else. The Rhinocerao of the Sunda Islands
differs from those of Africa, and there are none in America. The Elephant of Asia
differs from that of Africa, and there is none in America. One Tapir is found in the
Sunda Islands ; there is none in Africa, but we find one in South America, etc*
Everywhere special adaptation, particular forms in each continent, an omission of
some allied type here, when in the next group it occurs all over the zone."

Mr. Agassiz has so well expressed his opinion on another point, that
we cannot resist the temptation of making an additional extract.

" We are thus led to distinguish special provinces in the natural distribution of ani-
mals, and we may adopt the following division as the most natural. First, the Arctic
province, with prevailing uniformity. Second, the temperate zone, with at least
three distinct zoological provinces ; the European Temperate Zone, west of the Ural
Mountains ; the Asiatic Temperate Zone, east of the Ural Mountains; and the Ame-
rican Temperate Zone, which may be subdivided into two, the Eastern and Western,
for the animals east and west of the Rocky Mountains differ sufficiently to constitute
two distinct zoological provinces. Next, the Tropical Zone, containing the African
Zoological province, which extends over the main part of the African continent, in-
cluding all the country south of the Atlas and north of the Cape colonies ; the tropi-
cal Asiatic province, south of the great Himalayan chain and including the Sunda
Islands, whose Fauna has quite a continental character and differs entirely from that
of the Islands of the Pacific as well as from that of New Holland ; the American
Tropical province, including Central America, the West Indies and tropical South
America. New Holland constitutes in itself a special province, notwithstanding the
great differences of its northern and southern climate, the animals of the whole con-
tinent preserving throughout their peculiar typical character. But it were a mistake
to conceive that the Faunae or natural groups of animals are to be limited according
to the boundaries of the mainlands. On the contrary, we may trace their natural
limits into the ocean, and refer to the temperate European Fauna the eastern shores
of the Atlantic, as we refer its western shores to the American temperate Fauna.
Again, the eastern shores of the Pacific belong to the Western American Fauna, as
the western Pacific shores belong to the Asiatic Fauna. In the Atlantic ocean there

742 The New-Orleans Medical and Surgical Journal.

is no peculiar oceanic Fauna to be distinguished ; but in the Pacific we have such a
Fauna, entirely marine in its main character, though interspread with innumerable
islands, extending east of the Sunda Islands and Mew Holland to the western shores
of tropical America. The islands west of this continent seem, indeed, to have very-
Blight relations in their zoological character with the western parts of the mainland.
South of the tropical zone we have the South American temperate Fauna and that
of the Cape of Good Hope, as other distinct zoological provinces. Van Dieman's
Land, however, does not constitute a zoological province in itself, but belongs to the
province of New Holland by its zoological character. Finally, the Antarctic Circle
encloses a special zoological province, including the Antarctic Fauna, which in a great
measure corresponds to the Arctic Fauna in its uniformity, though it differs from it
in having chiefly a maritime character, while the Arctic Fauna has an almost entirely
continental aspect.

" The fact that the principal races of man, in their natural distribution, cover the
same extent of ground as the same zoological provinces, would go far to show that
the differences which we notice between them are also primitive," etc.

These facts prove conclusively that the Creator has marked out both
the Old and New Worlds into distinct zoological provinces, and that
the Faunae and Florae are independent of climate or other known phy-
sical causes, and it is equally clear that in this geographical distribu-
tion there is evidence of a plan — of a design ruling the climatic condi-
tions themselves.

It is very remarkable, too, that while the races of men, and the Fauna
and Flora of the Arctic region present great uniformity, they follow in
the different continents the same general law of increasing dissimilar-
ity as we recede from the Arctic and go South, irrespective of climate.
We have already shown, that as we pa?s down through America, Asia
and Africa, the further we go the greater is the dissimilarity of their
Faunae and Florae to their very terminations, even when compared to-
gether in the same latitudes or zones ; and an examination will show,
that the differences of types in the human family become more strongly
marked as we recede from the Polar regions, and reach their greatest
extremes at those terminating points of continents, where they are most
widely separated in distance, though occupying nearly the same paral-
lels of latitude, and nearly the same climates. For instance, the Fue-
gians of Cape Horn, the Hottentots and Bushmen of the Cape of Good
Hope, and the inhabitants of Van Dieman's Land, are the tribes which,
under similar parallels, differ most widely. The differences of races
are scarcely less marked in the tropics of the two continents, viz., the
Negro in Africa, the Indian in America, and the Papuan in Polynesia.
In the temperate zone, we have in the Old World the Mongolians and

Dr. Nott on the Geographical Distribution of Animals. 743

the Caucasians, and Indians in America, living in similar climates, yet
wholly dissimilar themselves.

History, traditions, monuments, osteological remains, etc., all show
that races have occupied substantially the same zones or provinces from
time immemorial. Since the discovery of the mariner's compass man-
kind have been more disturbed in their primitive seats ; and with the
increasing facilities of communication by land and sea, it is impossible
to predict what changes coming ages may bring. The Caucasian ra-
ces, which have always been the representatives of civilization, are those
alone which have extended over and colonized all parts of the globe,
and much of this is the work of the last three hundred years. The
Creator has implanted in this group of races an instinct, which in spite
of themselves, drives them through all difficulties, to carry out their
great mission of civilizing the earth ; it is not reason, or philanthropy,
which urges them on, but it is destiny. When we see great divisions
of the human family, progressing in numbers, spreading in all direc-
tions, encroaching by degrees on all other races, wherever they can
live and prosper, and gradually supplanting them, is it not reasonable to
conclude that they are fulfilling a law of nature ?

We have always maintained diversity of origin for the whole range
of organized beings. If it be conceded, as it is on all hands, that there
have been many centres of creation instead of one, what reason is there
to suppose that any one race of animals has sprung from a single pair
instead of many, and as we have written many years ago, "if it be con-
ceded that there were two primitive pairs of human beings, no reason
can be assigned why there may not have been hundreds."

Mr. Agassizthus expresses himself on this point :

" Under such circumstances, we should ask if we are not entitled to conclude that
these races must have originated where they occur, as well as the animals and
plants inhabiting the same countries, and have originated there in the same numeri-
cal proportions and over the same area in which they now occur ; for these condi-
tions are the conditions necessary to their maintenance, and what among organized
beings is essential to their temporal existence, must be at least one of the conditions
under which they were created.

" We maintain, that like all organized beings, mankind cannot have originated in
single individuals, but must have been created in that numerical harmony which is
characteristic of each species ; men must have originated in nations, as the bees have
originated in swarms,and as the different social plants have covered the extensive tracts
over which they naturally spread."*

We remarked in the commencement of this chapter that M. Agassiz

* See the Christian Examiner.

744 The New- Orleans Medical and Surgical Journal.

had presented his views in such a condensed and masterly manner, that
it would be impossible to attempt a resume, or to do him justice without
repeating the whole of his article, and although we have already used
him freely, we cannot resist the temptation of giving a concluding par-
agraph, as our object is more to give a synopsis or posting up to date
of the facts illustrative of our subject, than to claim any great originality
— if we can bring the truth out our object is attained.

" The circumstance that wherever we find a human race naturally circumscribed,
it is connected in its limitation with what we call in natural history a zoological and
botanical province — that is to say, with the natural limitation of a particnlar associa-
tion of animals and plants, — shows most unequivocally the intimate relation existing
between mankind and the animal kingdom in their adaptation to the physical world.
The Arctic race of men, covering the treeless region near the Arctics in Europe,
Asia and America, is circumscribed in the three continents within the limits very sim-
ilar to those occupied by that particular combination of animals which are peculiar to
the same tracts of land and s«a.

" The region inhabited by the Mongolian race is also a natural zoological province,
covered by a combination of animals naturally circumscribed within same regions
The Malay race covers also a natural zoological province. New Holland again con-
stitutes a very peculiar zoological province, in which we have another particular race
of men. And it is further remarkable, in this connection, that the plants and animals
now living on the continent of Africa, south of Atlas, within the same range within
which the negroes are naturally circumscribed, have a character differing widely from
that of the plants and animals of the northern shores of Africa and the valley of
Egypt ; while the Cape of Good Hope, within the limits inhabited by Hottentots, is
characterized by a vegetation and a Fauna equally peculiar and differing in its fea-
tures from that over which the African race is spread.

" Such identical circumscriptions between the limits of two series of organized be-
higs so widely differing in man and animals and plants and so entirely unconnected
in point of descent, would, to the mind of the naturalist, amount to a demonstration,
that they originated together within the districts which they now inhabit. We say
that such an accumulation of evidence would amount to demonstration ; for how
could it, on the contrary, be supposed that man alone would assume new peculiarities,
and features so different from his primitive characteristics, whilst the animals and
plants circumscribed within the same limits would continue to preserve their natural
relations to the Fauna and Flora of other parts of the world ? If the Creator of one
set of these living beings had not also been the Creator of the other, and if we did not
trace the same general laws throughout nature, there might be room left for the sup-
position, that while men inhabiting different parts of the world originated from a com.
moa centre, the plants and animals associated with them in the same countries
originated on the spot. But such inconsistencies do not occur in the laws of na-
ture.

" The coincidence of the geographical distribution of the human races with that of
animals, the disconnection of the climatic conditions where we have similar races,
and the connection of climatic conditions where we have different human races, show

Dr. Nott OTi the Geographical Distribution of Animals. 74§

further, that the adaptation of different races of men to different parts of the world
must be intentional, as well as that of other beings ; that men were primitively loca-
ted in the various parts of the world they inhabit, and that they arose every where
in those harmonious numeric proportions with other living beings, which would at
once secure their preservation and contribute to their welfare. To suppose that all
men originated from Adam and Eve, is to assume that the order of creation has been
changed in the course of historical times, and to give to the Mosaic record a mean-
ing that it never was intended to have. On that ground, we would particularly in-
sist upon the propriety of considering Genesis as chiefly relating to the history of the
white race, with special reference to the history of the Jews."

Zoologically, the races or species of mankind obey the same general
laws which govern other animals — they have their geographical points
of origin, and are adapted to certain external conditions which cannot be
changed with impunity. The natives of one zone cannot be transferred to
another without deteriorating physically and mentally. Races, too, are
governed by certain physiological influences, which differ among the
species of mankind, as do instincts differ among the species of the lower
animals. These physiological characters form one of the great mys-
teries of human nature ; they seem often to work in opposition to the
physical necessities of races, and to drive individuals and nations be-
yond the confines of human reason. We see around us daily, individ-
uals obeying blindly their psychological instincts, and one nation reads
of the causes which have led to the decline and fall of other empires
without profiting by the lessons.

The laws of God work not only through a few thousand years, but
through eternity, and we cannot see the why or wherefore of what
passes in our brief day. Nations and races, like individuals, have each
a special destiny ; some are born to rule, and others to be ruled, and
such has always been the history of mankind. No two well-marked
races can live together on equal terms. Some races, too, are destined
to live and prosper for a time till the destroying race comes, which is
to exterminate and supplant them. See how the Aborigines of Ame-
rica are fading away before the races of Europe.

That group of races which has been comprehended under the gen-
eric term Caucasian, have in all ages been the rulers, and it requires
no prophet's eye to see that they are destined eventually to rise and
hold every foot of the globe where climate does not interpose an im-
penetrable barrier — no philanthropy, no legislation, no missionary la-
bors can change this law : it is written in man's nature by the hand of
his Creator.

While the mind is thus speculating on the physical history of races

746

The New-Orleans Medical and Surgical Journal.

and the speedy extermination of some of them, other problems start up
in the distance, whose solution is far beyond the reach of human fore-
sight. We have already hinted at the mysterious disappearance of many
of the great races and nations of antiquity.

When the inferior types of mankind have fulfilled their destinies and
passed away, and the remaining ones have mingled their blood, wan-
dered from their primitive zoological provinces, and overspread the
earth, what will be the ultimate result? May not that law of nature
which so often forbids the mingling of species here do its work of de-
struction, and at some future day leave the fossil remains of man, alone,
to tell the tale of his existence on earth.

P. S. The Natural History of Mankind is now attracting great at-
tention in all parts of the world, and there is no division of it more
important or interesting ihan the Aborigines of America. These ra-
ces are fast fading away and their remains being destroyed ; and the
means of investigation thus diminishing from day to day. It devolves
more particularly upon the gentlemen of the medical profession of our
country to collect and preserve every thing which can throw light on
the subject, and I am disposed to do all 1 can to this end* I am par-
ticularly desirous of making a collection of Indian skulls, of either liv-
ing or dead races, and more especially those from ancient burial places,
mounds, etc., and if the members of the profession could send me spe-
cimens, they would not only greatly oblige me personally, but would be
aiding in the advance of science.

V.— EFFECTS OF QUININE ON THE PULSE— OPIUM-EATING, etc.

BY WM. M. BOLLNG, M. D., OF ALA.

[These cases were prepared for the press, we are informed by the
author, some months since ; but they did not reach us until some time
in March of this year. Ed.]

In the Transylvania Medical Journal for August, 1850, one of the
Editors, Prof Bullitt, after suggesting a theory as to the modus operandi
of the Sulphate of Quinine, in the cure of miasmatic diseases, remarks :
" This explanation would not answer, if it could be proved that the
pulse may be depressed much below its normal standard ; but this has
not been done. Although southern practitioners speak of the possibil-
ity of accomplishing this, we have met with no cases reported by them

Dr. Boling on the Effects of Quinine^ etc.

747

in which any thing more was claimed, than the reduction of the pulse
from the state of febrile frequency to a standard approaching the nor-
mal."

Although Southern practitioners may, in but very few instances, have
thought it worth while to report cases in detail, in which the pulse has
been reduced in frequency below the normal standard by the operation
of Quinine, a few such may be found on record ; and I have no hesi-
tation in saying that they are of daily occurrence in the hands of hun-
dreds of Southern practitioners. Indeed, should any Southern practi-
tioner be heard to say that he had never observed such an effect from
Quinine, there are many whom it would be difficult to convince, that
he appreciated its advantages, or could avail himself of its benefits to
the full extent in the treatment of our febrile and inflammatory dis-
eases.

I will, as briefly as possible, present from my case books, a few cases
of the kind.

CASE I.

This patient was a negro girl about nine years old ; seen first Octo-
ber 13th, 1841; her disease, comatose remittent fever, At the time of
my visit she was in the third paroxysm. I ordered enemata — each to
contain five grains of Quinine, to be given every third hour during the
exacerbation ; in the intermission, she was to take by the mouth four
grains every third hour, till three doses were given, and then it was to
be given in smaller doses at longer intervals. During the exacerbation?
(the case was a somewhat peculiar one) the pulse was 80— about the
natural standard. When I saw her the next day, under the influence of
the Quinine, her pulse was 68. The paroxysm did not return.

CASE II.

Was a pretty severe case of bronchitis, in a strong, muscular man,
about 45 years old ; seen first December 25th, 1843. On the 2d of
January his pulse was 70, and he was taking six grains of Quinine, two
grains of Blue Mass, and the eighth of a grain of Tartar Emetic every
third hour.

On the 3d his pulse was 68, and on the 4th it was 64 ; the same pre-
scription being regularly continued.

These two cases were reported more in detail in the American Jour-
nal of Medical Sciences for July, 1844, pages 105 and 109. There is a
typographical error in the prescription just referred to ; 4 grains instead
of 24 grains being puV down.

748 The New-Orleans Medical and Surgical Journal.

CASE III.

A negro man 45 years old, laboring under a very violent attack of
pneumonia, for which I visited him first March 29th, 1844. On the
2d of April (he having been taking for several days 8 grains of Quinine .
every third hour) his pulse was 64. On the 3d the same, — the pre-
scription being continued every fourth hour. On the 4th his pulse was
57; on the 5th 60; on the 6th 54— -the 8 grain doses of Quinine having
been continued regularly every fourth hour. He was improving, and
the doses were now given at intervals of six hours.

CASES IV.

A stout negro man, 35 years old, laboring under a severe attack of
pneumonia, for which 1 visited him first March 6th, 1844. For several
days prior to the 11th, he took, with other remedies, Quinine, in five,
eight or ten grain doses every fourth hour, and we find his pulse at 60.
Quinine continued, and on the 12th his pulse was 62. On the 13th
(the Quinine being continued in six grain doses every sixth hour) his
pulse was 54. As he was improving, the medicine was given at gra-
dually lengthened intervals, till his recovery.

case v.

A stout negro man, 27 years old, laboring under a severe attack of
dysentery and pneumonia; I visited him first on the 4th May,1844,though
he had been sick since the 28th April. On the 6th, (Quinine having
been given in six grain doses, every sixth hour) his pulse was 64. In
the evening it was 86. Nine grains every sixth hour, was the dose di-
rected, and on the 9th his pulse was 60. Six grain doses every fourth
hour were continued through the day, and the same every sixth hour
during the night. On the morning of the 8th his pulse was 50. Dis-
charged on the 10th.

The three last cases were published more in detail in the Western
Journal of Medicine and Surgery for December, 1844. Many more
such cases, I have no doubt, might be found scattered through my case
books, were it necessary to publish more, or had I leisure to search
them out.

Generally, I have kept daily records of only the more severe cases. *
In cases of less severity, there is generally much less difficulty in con-
trolling the pulse. The doses, as above given, to many Southern prac-
titioners, will appear small rather than large ; and in most of the cases
a further reduction of the pulse might have been produced by an in-
crease in the quantity of the medicine. A certain effect on the pulse — -

Dr. Boling on the Effects of Quinine, etc. 749

its reduction to something like the healthy standard, is a principal aim
with me, from the use of Quinine in the treatment of the phlegmasia;
and the quantity is regulated by the effect produced. I give generally
the smallest doses capable of producing this effect. When 6 or 8
grains every third or fourth hour fail, I prescribe larger doses, say 10 or
twelve grains. The pulse being once reduced by the larger doses?
smaller ones will generally suffice to keep it at the lowest standard.
It has rarely been an object with me to reduce the pulse below the heal-
thy standard, and generally in the cases in which this has happened, it
has been entirely accidental.

CASE VI.

Pneumonia. A negro man, 26 years old, having had " a cold" for
several days, was taken on the night of August 8th, 1844, with a chill,
followed by a troublesome cough, and pain in the right side. He has
taken a dose of calomel and oil; bowels loose ; chest and head hot ; ex-
tremities cool ; dulness on percussion, with absence of respiratory mur*
mur over lower third of right lung. The respiratory murmur is feeble
in the remainder of the right lung, and slightly purile in the left ; ex-
pectoration viscid and of a brownish tinge ; pulse 92 and corded. He
was ordered 5 grains of calomel and a quarter of a grain of opium, to
be taken immediately. Sulphate of Quinine and Ex. of Cinchona, of
each 22^ grains, to be divided into nine parts, two of which also are to
be taken immediately, and one every second hour.

lkth. Pulse 90; has had several evacuations ; otherwise the same.
Directed Sulphate of Quinine 32 grains, to be divided into eight parts,
two of which are to be taken immediately, and one every two hours af.
ter. Also, Calomel grains v, Morphia one third of a grain, to be ta-
ken at bed-time.

18th. Pulse 88; bowels loose ; dulness less extensive ; cough and
pain continue. To take five grains of Calomel and half a grain of
Opium now, and the same at bed-time ; also, four grains of Quinine
every second hour.

16th. Pulse 90; continue the Quinine. Evening, pulse 84; cough,
dullness, etc., abating. Continue the Quinine ; also the Calomel and
Opium.

17th. Pulse 48 ; several evacuations ; much improved ; omit the
medicine.

Evening. Pulse 47 ; recovered rapidly.

CASE VII.

Pneumonia. Is long and need not be given in detail. Mr. Gay*

750 The New-Orleans Medical and Surgical Journal.

about 45 years old, had on the 13th December, 1844, a chill, followed
by cough and severe pain in the left side. I saw him first on the 18th.
His fever has continued high ever since the chill. His cough is fre-
quent, and attended with a tough, viscid, though not bloody expectora-
tion. Severe pain in the side. Dulness on percussion over the lower
part of left lung. Bronchophony and bronchial respiration. Mucous
rale in the right. He was directed to take small doses of Blue Mass,
and six grains of Quinine every fourth hour.

On the 21st, pulse 70 ; crepitant rale of resolution heard in the for-
merly hepatized portion of the left lung. Expectoration free, and of a
yellowish brown tinge. Continue the Quinine.

In the evening, pulse 64. Continue Quinine.

22d. Pulse 61. Continue Quinine.

23d. Pulse 57. Continue Quinine.

24:th. Pulse 58. Dulness much less extensive. Continue the Qui-
nine.

He rapidly recovered — the pulse for several days beating from 68
to 66.

In a few cases, under certain circumstances, I give a^single dose at
first of 20 or 30 grains, and afterwards keep up the effect by the regu»
lar administration of smaller doses.

OPIUM-TAKING.

In the London[;Lancet for August, a correspondent, over the signa-
ture of Medicus, asks, " Is it possible to reform a person who has long
been addicted to the practice of taking opium ?" * * * " Are we
to consider entire abstinence impossible when the practice has been
indulged in upwards of two years ?" * * * " Should the patient
be advised to leave it off totally, and at once, or do you recommend a
gradual diminution of the dose ?"

To these enquiries, in the succeeding number of the Lancet, we find
several answers. One correspondent advises the morphia to be with-
drawn gradually, and to substitute in its stead small doses of the Tinc-
ture of Lobelia and the Tartrate of Antimony. Another says, that "it
is no more possible to reform a person who has been long addicted to
the practice of taking opium, than it is to reform a patient who is par-
alyzed ;" (!) but recommends alcohol as an antidote ; and mentions the
case of a gentleman who was cured by being intoxicated with claret

Dr. Boling on the Effects of Quinine, etc.

751

two evenings in succession, and put to bed in that condition. Another,
however, who had long been addicted to the use of opium, observes,
that among other things, he had taken brandy to excess, without relief.
Still another, in his own Case, adopted the following plan. He prepa-
red three pints of a solution of morphine, and each time, on taking out
his daily dose, replaced the quantity removed with water, and suc-
ceeded by thus very gradually reducing the strength of his dose.

I have had two cases of opium-eating to treat. The first, a delicate
nervous female, fell into the habit some eight or nine years ago, of ta-
king morphia for the relief of neuralgic pains, and continuing the habit
■ after the cause which first led to it was removed, at the end of about six
or seven years she consumed daily|from six to eight grains of morphia.
I attempted the immediate suspension of the habit, but found it impos-
sible, so great was the suffering, both physical and mental. Feelings
of the utmost wretchedness, prostration, excessive suffering from pains
in the limbs, trembling, cold sweat, and small and thready pulse oc-
curred. The attempt was abandoned, and I adopted a plan similar to
the one recommended in the last case. After testing the matter, I as-
certained that she could get along, without much suffering, on a dose
twice a day of one grain. I prepared six ounces of a solution, contain-
ing a grain to the drachm, and advised her to take a teaspoonful twice
a day, and each time to replace the quantity removed with water. The
strength of the solution, however, seemed to be diminished too rapidly,
for after a few days, considerable suffering for lack of the stimulus oc-
curred. I then prepared six ounces of a weaker solution, and instead
of water, replaced each dose from it. After this was used, I prepared
a still weaker solution, and used it in the same way. When this was
gone, the dose was replaced by water ; and thus, by very gradually
reducing the strength of the solution, the cure was completed in three or
four months.

The other was the case of a gentleman, otherwise in good health,
who had thoughtlessly fallen into the habit of taking opium in various
forms, say to the amount of three or four grains a day ; but for some-
thing less than a year. I suggested to him the gradual withdrawal of
the drug in the manner just mentioned ; or its immediate suspension,
and the use of other agents, with the view of counteracting the depres-
sion following. He chose to attempt the latter, and after suffering
greatly, mentally and physically, for three or four months, during the
greater part of which time he lay in bed, a cure was effected. Va-

752

The New-Orleans Medical and Surgical Journal.

rious remedies were tried, with the view of mitigating his suffering dur-
ing the time, none of which seemed to produce any appreciable effect ?*
porter, ale and lupulin excepted. It is not probable, however, that either
of these remedies would be of any service to the porter-drinking Eng-
lishman.

VI. -THE NEGRO AND HIS DISEASES.

BY S. L. GRIER, M. D., OF MISS.

In calling attention to a few of the diseases which may be considered
peculiar to the negro race, it will not be necessary to enter upon the
question so much vexed in our day, as to whether the human race is
derived from one original stock, or from a diverse species. For our
present purpose it is sufficient, that different varieties are universally
acknowledged to exist, and we suppose it will be quite as readily con-
ceded that these varieties, however derived, are hardly more distin-
guished by temperament, personal appearance, language, customs, or
habits of life, than by certain constitutional tendencies and liabilities to
disease, which have descended with the sentence of death that was pro-
nounced upon at least one pair of the original progenitors. Of the
ethnological question involved, we, of course, have an opinion. We be-
lieve firmly in the Bible-taught doctrine of the unity of the human race,
and that " God hath made of one blood all nations of men, for to dwell
on all the face of the earth ;" but some construe this differently, and
however it may be, all will agree with us, that whether these races be
derived from one or more original species, they are now characterized
by such peculiarities of constitution and temperament, as to make the
distinctive maladies of the negro race a subject of much practical impor-
tance to us, and worthy of a more pains-taking investigation than it
has ever yet received from the hands of the medical profession of the
South.

In the few observations we have to make in reference to the peculiar
diseases of the negroes, our aim will be simply to express the wants of
a portion of the Southern medical profession, in the hope that others,
more capable, and whose appropriate vocation it is, will at least make
an effort to supply the desideratum.

The first form of disease which assails the negro race among us is
Trismus. The mortality from this disease alone is very great. No

Dr. Grier on the Negro and his Diseases.

758

statistical record, we suppose, has ever been attempted, but from our
individual experience, we are almost willing to affirm that it decimates
the African race upon our plantations within the first week of indepen-
dent existence. We have known more than one instance in which, of
the births for one year, one half became the victims of this disease, and
that, too, in despite of the utmost watchfulness and care on the part of
both planter and physician. Other places are more fortunate, but all
suffer more or less, and the planter who escapes a year without having
to record a case of Trismus Nascentium, may congratulate himself on
being more favored than his neighbors, and prepare himself for his own
allotment, which is surely and speedily to arrive. At least ninety per
cent of the number of cases prove fatal, and yet for this affection, so
common and so destructive to life, we doubt whether the first step has
been made towards a successful treatment ; nor is it to be expected that
the therapeutics of the disease can be established, while the pathology,
not only of Trismus Infantum, but of all tetanic affections, remains in-
volved in so much obscurity. True, the Eureka outcry has been heard
over a variety of means and measures for the relief of this class of dis-
ease, but it has invariably been followed by a silence so ominous and
suggestive of misplaced confidence, that any new discoveries of that
stamp are unanimously submitted to the same test of time. The re-
semblance which Trismus Infantum bears to Traumatic Tetanus, has
perhaps given rise to the opinion, that the exciting cause was to be
found in the unhealed state of the umbilicus, and various applications,,
emollient and sometimes stimulating, are used to guard against its oc-
currence. The decided efficacy of these or any other prophylactic
means, has yet to be demonstrated. We remember, too, that during
our novitiate in New Orleans, we listened, with the medical class, to a
very entertaining lecture delivered before the Physico-Medical Society,
by Dr. Sims of Alabama, on the subject of Trismus Nascentium. The
cause he referred to a displacement of the occipital bone, and conse-
quent compression of the cerebellum, medulla oblongata, and the nerves
arising in that vicinity. The treatment advocated by Dr. S. was the
elevation of the depressed bone, with the necessary directions as to po-
sition, to prevent a recurrence of the exciting cause. We received
these new views with much interest, made a note of the suggestions of
Dr. S., and with an undoubting confidence in the progress of science,
we felt armed on that point at least. We cannot say that our hopes
have been fully realized. We soon had occasion to test this mode of
treatment. The first few cases that fell into our hands, we omitted the

754 The New-Orleans Medical and Surgical Journal.

manipulations with the awl, not being able to make out the requisite
indications for its use, and perhaps the natural timidity of a tyro may
have made us averse to gouging the brain of tender infancy, but we
zealously maintained for our patients the anti-trismal position until death
closed the scene, and at the same time quenched all our sanguine ex-
pectations founded on the new mode of practice. If others have been
more successful with it, or if Dr. Sims has been confirmed in his views
by later experience, we would be pleased to hear of it, as the cure of
Trismus is with us a matter of special interest. We are free to con-
fess that we have nothing more effectual to propose in the management
of this disease, and therefore are fore ed to fall back uyon a positive
inability to treat a case of it with any rational hope of success. At
every period of life the negro is liable to tetanic affections, and almost
inevitably sinks under them. We are glad to learn that the quinine
treatment is sometimes successful. We have had the misfortune to
fail with it, except in one solitary instance, and the probability is, that
it was but the simulation of tetanus we were then called upon to treat.
The most favorable results in the treatment of these diseases that we
have yet been advised of, was in the practice of the estimable and now
lamented Dr. Volney Metcalf of Natchez. His reliance in tetanus
was chiefly in the use of the hot sand-bath, combined with opiates in.
ternally. Under these means, he assured the writer some few years
since, he had seen four cases in five recover, and one of these a case
of Trismus Nascentium. His views on this subject are entitled to the
more confidence, as he was, of all men, least disposed to what seems
a besetting sin of the medical profession — a disposition to magnify into
undue importance any particular plan of treatment which, in their hands,
has for a time been attended with an unwonted degree of success. It
is proper however to state, that Dr. M.'s mode of practice has not been
found so efficient in the experience of some of his confreres.

The next disease peculiar to negroes in our climate, to which we
would ask atten tion is Marasmus. We use this as a generic term, intend-
ing it to embrace a class of diseases to which negro children are liable
between the second and fifth year, and though second to Trismus in
regard to time and relative mortality, it has the precedence in point of
frequency. After the first period of ten days has elapsed, the child is
absolutely safe from the ravages of Trismus, a nd during the period of
first dentition is comparatively free from any disease that might be
styled peculiar; but after it is removed from the breast, and generally
in the second or third year, it falls subject to the disease we have called
Marasmus, in the absence of a more rigid nomenclature. It is literally

Dr. Geier on the Negro and his Diseases.

755

a ft. wasting away" — a tabes. The peculiar affection of the mesentery
known to us as mesenteric consumption, may be classed with it, but in
a majority of cases no such local affection exists, nor does an autopsical
examination reveal any signs of the tubercular diathesis. No disease
is more common among negro children, nor is there any attended with
a greater aggregate mortality. It corresponds in this respect with the
cholera infantum of Northern cities. On some plantations, one half
or more of the children fall victims to it. It is a fact palpable and strik-
ing, that while the increase of some places is so great, from ten, fifteen
or twenty women having children, as to enable the planter in the
course of as many years, to colonize and cultivate a new plantation
from the natural increase alone, other places alike prolific, or nearly so,
raise no children. They all die in infancy or early childhood, and it
is this disease that we are endeavoring to describe which carries most
of them off. It is styled provincially " the drooping disease of negro
children," and this name expresses its character better, perhaps, than
any we can apply to it. It commences with languor, fretfulness and
loss of strength. The child gradually becomes emaciated, and along
with this comes on increased appetency for food. Diarrhoea supervenes.
The patient becomes rapidly anaemic. Soon we notice a serous effu-
sion into the cellular tissue of the extremities. Sometimes with a tu-
mid abdomen, or it may be a general anasarca. There is, too, irrita-
tion of the nostrils, the mouth often covered with apthae, and in many
cases extensive abrasion and sloughing of the skin in different parts.
Here, if not sooner, fever complicates the case, and perhaps for the first
time a physician is called in, who sees the child expire in a day or two,
sometimes in convulsions, more frequently of asthenia — a total exhaus-
tion of the vital powers ; and upon a post mortem examination, no or-
ganic changes are found, except it be occasionally the mesenteric af-
fection before referred to, and more rarely an engorged and hypertro-
phied condition of the liver. For the most part, we can determine no-
thing except a general state of anaemia. Evidently there is some le-
sion of nutrition, but upon what dependent is the question. We are
inclined to the belief, that the exciting cause is in some functional de-
rangement of the portal system, but can offer this only as a conjec-
ture.

The treatment of this disease is a matter of much interest to those
of us who are called to practice in several districts, and among that
class of persons peculiarly liable to it. Our text-books and journals
give us little aid in controlling it. Nor is it to be expected that they
can afford us much assistance in regard to the therapia of a disease, of

756 The New-Orleans Medical and Surgical Journal.

the very existence of which they seem to be ignorant. True, in cer«
tain works that treat of the diseases incident to hot climates, we find it
sometimes described, and like all diseases of that class, vaguely attri-
buted to biliary derangement, and of course a mercurial treatment in-
dicated ; but in our modern authorities that profess to give us the latest
improvements in pathology and practice, we find not a word concerning
it. Neither Wood nor Watson make mention of it. Therefore we
say, happy is the man who is independent of the schools and text-books
and medical authorities of the day, and who can call to his aid other
resources in the hour of need. In this disease, especially, does it be-
hoove Southern practitioners to be a law unto themselves. Verily the
gods on our medical Olympus will do little for the man who cannot put
his shoulder to the wheel and help himself. It is not within the limits
of our present purpose, nor do we profess to be able to make a scien-
tific demonstration of the pathology of this disease. We are constantly
called upon to treat, and may sometimes be able to contend with it, with
a measurable degree of success, but we are reluctant to throw before
our professional seniors the crudities of an empyrical practice, and
therefore prefer to await the opinion of those to whom an ampler range
of experience has given the right of priority in the discussion of this
matter. True, it may be said that the primary cause of this affection
will be found in the violation of some hygienic laws, and that it is the
result of plantation mismanagement and maltreatment of negroes, which
makes it so much more common and fatal on one place than another ;
but this does not make it at all less within the scope of medical enquiry ;
nor do we find it practically to relieve us from the responsibility its
mortality entails upon us. The cause, the pathological phenomena
which mark its course, through the various stages of development and
progress, and the treatment, hoth prophylactic and curative, have yet,
so far as we are acquainted with the subject, to be reduced to a scientific
formula. At some future time we may have something to say on these
points ; for the present we dismiss the subject, and pass on to notice
some of the other diseases prevalent among the slave population.

Invermination is a common affection of the negroes during childhood,
as might naturally be expected. It frequently gives rise to secondary
affections more serious and fatal;during the summer and autumnal months
fevers are often produced from this cause ; and at all seasons, convul-
sions, dysentery, and many disorders of the alimentary canal are likely
to complicate the original disease. These cases will of course require
their specific treatment ; but there is a prophylactic measure resorted
to on most well ordered plantations, which anticipates and averts this

Dr. Grier on the Negro and his Diseases.

757

whole train of evils, and which cannot be too earnestly recommended.
It consists in the periodical administration of two or three successive
doses of some anthelmintic preparation, generally a decoction of spi-
gelia, chenopodium, or of the root of the melia azederach, and after this
course a purgative dose. This is repeated at monthly periods, and ac-
cording to some domestic authorities, at a particular phase of the moon.
The special crisis in lunar affairs which favors these designs on the
verminose tribes, has unfortunately escaped our memory.

The Cachexia Africana, or dirt-eating of negroes — the subjects of
this peculiar affection are chiefly among the ^adults of the race, but it
will generally be found that the habit has been formed in early life. On
nearly every plantation persons will be found addicted to this habit, but
in some sections of the country it is much more frequent than in others.
Among those engaged in the cultivation of sugar cane it is more com-
mon than in the cotton-growing region. This grovelling propensity
must have been brought from their native land by imported slaves; and
the extreme avidity with which an African will pounce upon an earth-
worm, and other luxuries of the same class, is but a refinement of the
same singular taste. Sometimes a dirt-eating mania will seem sud-
denly to take possession of the inhabitants of a place, and rage with al-
most epidemic violence. In one instance that came under our observa-
tion, a plantation was depopulated within the space of one or two years.
It is rare, however, that we witness such ravages from this disease*
Like the passion for alcoholic drinks, it has all grades of intensity-
some are only moderate dirt-eaters, and are able to gratify the appetite
without serious detriment either to health, or what they care more for
—reputation. The suspicion of dirt-eating is considered among them
as an indelible stain. There is no crime they commit more stealthily,
and if charged with it, they will most pertinaciously, and even with
their dying breath, deny it. In contrast with the class of moderate dirt-
eaters, there are others, who seem to have no control over their appe-
tite, and indulge in the pernicious practice with all the eagerness and
relish of the incorrigible topers. They are the sots in this species of
intemperance, and exerting no control over the grovelling taste, they
with an awful rapidity anticipate their doom. " Like to like" is invari-
ably a false principle, and in the attempt to feed on man's original ele-
ments, the poor negro soon returns " earth to earth."

The effect of dirt-eating upon the constitution, and the symptoms
which indicate the indulgence of such a habit, are too well known to
require a repetition here. All have noticed and can recognize at a
glance, the peculiar physiognomy, the livid and ghastly expression of

758

The New Orleans Medical and Surgical Journal,

countenance — a general anaemia prevails, the pulse is full, soft and
bounding, partaking somewhat of the character of the hemorrhagic pulse
■ — there is also the tumultuous beating of the heart, and a dyspnoea,
brought on by the slightest exertion, which, in their phraseology, is
termed " short-winded ;" the tongue loses its natural color, and its
blanched appearance gives one at first sight the idea of a coating ; dur*
ing the latter stage there is generally a dropsical effusion, either into the
cavities of the body, or into the cellular tissues. The treatment of this
disease is worthy of consideration ; for, although it be mainly a moral
rather than a physical disorder, the physician is expected to furnish a
remedy. Drugs will not be found of any service in this complaint. No
medication of this sort will be at all available, while the producing
cause remains in operation. The habit must be broken, and then the
natural restorative powers of the system will be sufficient to effect a
cure. This is, of course, a sine qua non'm the treatment, and it is folly
to talk of dosing it after the manner of a pharmacopoeia. Something
of this kind might indeed be offered in the shape of a substitute. We
have heard of the good effects of carbonate of iron given for this pur-
pose, and we fancy the use of tobacco might serve a similar purpose.
The latter would be comparatively harmless, as the race is not of a tem-
perament to be affected by its use. The constant supply of it by the
planter would at least furnish a quid pro quo. The greatest benefits,
we are inclined to think, will be gained by a proper attention to the
discipline of negroes, and the employment of all those means calculated
to improve their morale. We know not how Homoeopathy treats this
disorder, but we can conceive of no plan for a consistent globulist to
pursue, but faithfully to administer pillules of the pathogenetic substance.
" Similia similibus curantur /"

In one of the early numbers of this Journal, an elaborate article on
the subject of Cachexia Africana will be found, from the pen of the late
Prof. Carpenter, of the University of Louisiana. It is an able exposi-
tion of the subject, and will amply repay perusal.

Of the acute diseases to which negroes, as a race, are liable, per-
haps the most important is Pneumonia. The whole class of inflamma-
tory pulmonary affections is more common among them than among
the whites, and vastly more fatal. More especially is this greater mor-
tality to be alleged of Pneumonia. So that of late years it has gained
for itself the title of the 'i opprobrium medicorum." There is nothing
for which we hear such frequent, calls upon medical men to settle upon
some definite and intelligent mode of practice. The contradictory sen-

Dr. Grier on the Negro and his Diseases.

759

timents of the profession in regard to it are not confined to this country
alone. In foreign journals we notice the same diversity of opinion.
While some are strongly advocating an expectant treatment, others are
as strenuously contending for a course of active depletion and free me-
dication, and what is perhaps more remarkable, each party will bring
abundant statistical proof to support their favorite theory and practice.
We can only infer from this, that the combatants have examined this
subject from different points of view. Like the fabulous shield, it may
possibly have more than one aspect. We doubt the ability, and there-
fore we question the propriety of any one undertaking to determine and
dictate through the pages of a journal, whether or not blood-letting is
required in the treatment of Pneumonia. Such a decision is too gen-
eral and savors of dogmatism. We subscribe to no such unconditional
verdict. There are modifying influences to be first taken into the ac-
count. What is the type of the disease 1 Is it sthenic or asthenic ?
bilious or typhoid 1 simple ^or complicated 1 These different types
certainly demand a varied treatment. Again, has the stage of the dis-
ease nothing to do with our decision 1 We fancy a general blood-letting
in the primary stage of engorgement is a very different thing from ac-
tive depletion in the later stages, when hepatization exists. And to re-
turn from a digression, does not the race with us suggest some modifi-
cation in the treatment. As a rule, the negro will not bear depletion
so well as the white man, whereas counter-irritations seems to be pecu-
liarly applicable to them. The blister in inflammatory, like firing in
neuralgic affections, is more than ordinarily efficacious when used
with them. Nevertheless, general depletion is often beneficial in the
treatment of the Pneumonia of negroes. In a majority of cases that
have come under our care, we have used the lancet, and without any
after occasion for regret, although we were fully advised at the time,
that an unfavorable event would be attributed to its use. There is a
prejudice existing outside of the profession against the use of the lancet
in Pneumonia, and it exists very much to the embarrassment of the prac-
titioner. Pneumonia is frequently fatal in both races, and when gen-
eral blood-letting has been a part of the treatment, the physician may
expect to find the responsibility fixed upon the point of his lancet. This
erroneous impression in regard to general depletion, has doubtless been
produced by the disputings of the profession on the same question, and
the bitter fruits of these wranglings is thus commended to their own
acceptance.

The type of Pneumonia most dreaded among the negroes is the ty-
phoid, and the epidemic form it so frequently assumes among them, has

760 The New-Orleans Medical and Surgical Journal.

made it perhaps the most formidable disease we have to contend with.
It is now a trite remark, that our winter diseases are more unmanage-
able than the class of summer fevers. To discuss the pathology and
treatment of this disease, would extend this article beyond its proper
limits; it is a subject, however, which demands investigation, and it
becomes those who are interested to record their experience and let all
have the benefit of their observations. The subjects of Pneumonia are
chiefly adults, and perhaps the mortality is greater among them than
from any other disease which afflicts our slave population. Unlike some
of the other affections which we have adverted to, it is a disease that
medicine is expected to control, and which there is no reason a priori
to suppose would be the theme of such diverse sentiments among med-
ical men.

Dysentery is sometimes seen to take on a peculiar form among ne-
groes. We know not how extensively this form of disease may have
been noticed among them, or whether i^ should not be considered a
modification of the disease induced by a hot climate. We refer to a
form of Dysentery marked by the peculiar urgency of the symptoms,
and by the rapidity with which it runs its course. Its character might
perhaps be best expressed by placing it midway between the ordinary
form of dysentery and cholera, as it partakes of the nature of both.
The characteristic symptoms of hemorrhage, tormina, and tenesmus,
are always present and serve to identify the disease, generally running
its course in three or four days. The discharges are more copious,
and unlike the disease as described in the books, the transition seems
to be immediate from the stage of inflammation to that of mortification
and sloughing, without the ulcerative process that ordinarily intervenes
The treatment must of course be prompt and energetic ; and we are
inclined to believe that the early use of the lancet is an essential means
in the endeavor to control it.

There are other diseases that we find prevalent among the negro
population, and which might be styled in a measure peculiar to them.
In fact, there are few, perhaps, that would not require a modified form
of treatment., were we better acquainted with the physiology of the
race — or at least with their pathology ; for we notice some writers are
willing to admit their different pathology, who deny a distinct physiol-
ogy ; a distinction, we confess, we are at a loss to comprehend, seeing
that pathology is itself but a morbid physiology- — "the physiology of the
sick room." But apart from this question, the circumstances, occupa-
tions, and habits of life, are sufficient to impress a distinctive character
©n diseases to which negroes are liable.

Dr. Grier on the JSegro and his Diseases.

761

There is a large class of complaints peculiar to females, to which
many of that race are subject — various functional derangements of
the generative system, and mechanical displacements still more com-
mon. The diseases of the integuments, we may observe, too, require
other means of diagnosis than those laid down in the books, as do also
many of the exanthemata.

Rubeola, we submit, is simply a misnomer. Scarlet Fever is a term
which loses much of its significance when applied to them. When
called upon to establish the diagnosis of Typhoid Fever, the student of
Louis and Bartlett will derive but little aid from the pathognomonic
rose colored eruption, on which so much stress is laid by those authors.
All this may be called quibbling, and deemed of no importance, nor do
we attach any weight to it, except that it may represent how little dis-
crimination is made in the description of other symptoms of disease
less palpable to the senses. There are many physicians, the bulk of
whose practice lies among the slave population, and whose interest has
certainly not been consulted by the authorities in medical literature ;
and our object in making these few desultory remarks on some of the
prominent diseases among negroes, has been, mainly, to call attention
to the wants of the profession, and of the public also, in this matter.
Certain we are that they have not heretofore been recognized. So far
as we have noticed, but one writer has made this the subject of discus-
sion. Such indifference to local grievances, is not characteristic of me-
dicine alone in these Southern States ; but with this alone we have to
do at present, and we demand that the subject receive the consideration
its importance calls for. Upon the Medical Schools and Medical Col-
leges of the South this duty primarily devolves. True it is, that our
Medical Journals are doing good service, and are conducted in a spirit
worthy of the position they occupy ; but will they assert that due prom-
inence has been given to the particular department of medicine for
which we plead ? To our Medical Schools also we look for a reform
in this matter. May it not be because our Southern Schools are formed
and conducted on Northern principles, that so many disregard the in-
ducements held out by them, and go elsewhere for education ? We
regret, when young men seeking the profession, solicit our advice in the
choice of a school, that we cannot present the claims of our own insti-
tutions in a more attractive light. That they do possess superior ad-
vantages, we are free to admit ; but this superiority does not consist in
any special adaptation their instructions have to the wants of the rural
districts of the country, in which a large majority of their students must
naturally find their sphere of action. We believe that they would con-

762

The New-Orleans Medical and Surgical Journal.

suit their own interest, by making a provision for these wants ; and
that a course of lectures devoted to this specific purpose, would rapidly
inure to their own benefit. Such a thing we hold is practicable. Let
the diseases of negroes be united with the class of diseases incident
to warm climates, and they will together afford a field of sufficient ex-
tent for a distinct professorship, and second to none in point of practical
importance. We predict that the institution that shall originate such
a course, will find that the effort to thus signalize itself as a Southern
Medical School, will be soon recognized and appreciated by those whom
it may concern, and that its halls will be immediately crowded by a
host of eager students from all parts of the slave-holding territory.

But it is not as a measure of policy that we suggest this course. As
such, it is simply none of our business. It is rather the utterance of a
want felt throughout the length and breadth of the land ; and the duty in
regard to it is enjoined upon us with higher and more urgent claims.
We have a population of three millions of the African race, placed in
a position which gives them peculiar claims upon the race which holds
them in servitude. They are, too, we may add, the most useful class
of operatives now on the face of the earth ; and this subject is invested
with still more interest, when we consider how intimate the commer-
cial and general prosperity of the country is connected with the physi-
cal well-being of these slaves. It is not only a subject for the lover of
science to investigate; it is also a question of vital import in political econ
omy. The magnitude of the subject can be reckoned by dollars and cents
For illustration, let any one compute, if he can, the increased value of la
bor to the South, by the use of cinchona, and the discovery of its al
kaloid principles ; and the effect it has had to promote a general pros
perity. The influence of medicine, in this respect, is not generally ap
preciated, but it has a position and weighty influence, which is suscep
tible of proof. We therefore assert that the hygeine and medical treat
ment of negroes are subjects of the utmost importance, and demand a
still more specific investigation than they have yet received at the hands
of the medical profession.

To our Medical Schools we look for help in this matter. Our own
experience has taught us how little reference the ordinary course of
preparation has to the course of practice to which most students are
destined. We remember how we paced the typhus-crowded wards of
a hospital, in the daily rounds of clinical instruction. Fortunate is he
whose mind alone is contaminated in the study of these metropolitan
diseases. It may perhaps be worthy of remark, that we have not seen
a case of typhus fever since, and possibly we never may ; but we have

Dr. Grier on the Negro and his Diseases.

763

been constantly witnessing a class of diseases, which are as effectually
ignored by the medical schools and text-books of the day, as though
the African race had not its existence in our midst. We import the
productions of a prolific English press, and by the very same ship they
send us an accompaniment of diseases to illustrate their views and sub-
stantiate their theories. The North furnishes our students with their
" horn-books of medicine," and along with them they send their pulmo-
nary invalids, that they may learn to practice with stethoscope, and by
its use verify their skill in diagnosis. From both sources, journals
come to us filled with learned essays upon urinary diseases, and the
latest improvements in that department of surgery. But typhus and
phthisis, and a large proportion of these urinary diseases, are but the
exceptional cases with us, and we read of them rather as matters of
pathological interest, and curiosities in science, than for any practical
bearing they may have on our own affairs. Meanwhile, we look in
vain for any corresponding aid in the treatment of diseases incident to
our own climate and population— particularly of that part of the popula-
tion, whose labor is the source of so many benefits to the community
at large — of those, whose labor not only freights our ships, stocks our
warehouses, and rears our great commercial cities, but which also builds
our colleges, supports our hospitals, and endows with princely munifi-
cence our budding universities — which supplies us with so many of the
comforts and luxuries of life, and which even procures for us the ability
to regale with an entertaining foreign literature, and the means whereby
we appropriate to our own use the productions of other lands. In all,
therefore, wTe repeat, that relates to the welfare of the negro race, we
have a common and abiding interest, and in regard to it, the medical
profession has its appropriate duty to perform. Let us beware, lest
we prove recreant and fail to meet the claims that are upon us. These
are emphatically the days of reform. We hear the cry, loud and oft.
repeated, for independence, self-protection and Southern interests. In
the science of medicine, there is no choice between a foreign supply
and home production. Our medical literature cannot be manufactured
for us abroad. There is a necessity for combined action among our-
selves, and for more strenuous efforts in our own behalf. The appear-
ance of a new work on " Southern Practice," just announced by the
press, will be waited for with more than ordinary interest. We hail
the " Lone Star" as the harbinger of better things. It is optional with
us either to produce for ourselves a literature, or remain, as heretofore,
destitute.

Whether such a medical literature shall be supplied, suited to the
wants of the South, and self-sustaining, will depend on the fidelity of
her own sons.

764

The New-Orleans Medical and Surgical Journal.

VII.— WOUND OF ABDOMEN— FOLLOWED BY HERNIA OF STO-
MACH AND STRANGULATION — CONTENTS OF THIS ORGAN
DISCHARGED BY PUNCTURE -REDUCTION AND CURE.

BY A. E WING, M. D., OF LA.

The following case, which occurred in my practice last Spring, is
submitted without comment, with the b^ief that it may prove interesting
to the readers of the Journal, as well on account of its rarity as the
success which attended the treatment.

I was called in the month of April, 1852, to see a negro man,— -the
property of John E. Hammons, Esq., of Carroll County, Miss., --who,
Sn a rencounter with the owner, received a penetrating wound between
the ninth and tenth ribs, about one third their length from before. The
injury had been inflicted with a common pocket-knife, the blade of
which measured about four inches ; and upon examination, the base of
the left lung was found to have been slightly wounded, Which was man-
ifested by the escape of air at each respiratory act— the knife penetrat-
ing the diaphragm, its point wounded the omentum ; the stomach, how-
over, escaped.

The wound was inflicted at the beginning of the affray, and the sub-
sequent struggling (for he continued to resist afterwards) caused the
stomach to protrude through the wound, which was about two inches
long and parallel with the ribs. The tumor formed by the protruding
stomach was so large, that it could with difficulty be grasped with both
hands* and was filled with an undigested breakfast \ the accident hav-
ing occurred about an hour subsequent to that meal.

Upon my arrival, I attempted the reduction of the protruding viscus ;
but soon found that it could not be accomplished by the use of any jus-
tifiable amount offeree. In the meantime vomiting supervened, which
increased the difficulty still more, by forcing into the tumor an additional
amount of its undigested contents.

Having no instruments with me, I was under the necessity of sending
five miles for them, which necessarily caused a delay of three hours ;
by which time there was a strong tendency to strangulation ; the ves-
sels of the stomach were turgid and dark, from the obstacle to the free
escape of venous blood. I proceeded to enlarge the external wound to
the extent of about three inches, which, however, did not enable me
to effect reduction, but seemed to relieve, to some extent, the strangula-
tion, by allowing the vessels to empty themselves. The external wound
now measured near five inches, yet owing to the unyielding nature of its
boundaries above and below, I was prevented from replacing the por-
tion of the stomach protruding ; and it was deemed advisable, indeed

Dr. Scruggs on Quinine in Typhoid Feber.

?65

imperatively necessary, to empty it of its contents. Accordingly, in
the presence of Doctors Hart and Clarke, an incision was made into
the organ sufficiently large (say an inch and a half) to turn out the con=
tents, which, it is needless to state, were identical with those ejected
by vomiting. This opening was made about two inches from the car-
diac orifice.

After thus relieving the organ, the necessary care being used to pre-
vent any escape into the peritoneal sac, the wound was then closed by
four tightly drawn stitches of the interrupted suture ; accurate approx-
imation of the edge of the wound being thereby effected ; the organ
then being restored, the external wound was likewise closed by a half
dozen stitches of the same suture. He was then ordered an enema,
and left, to be seen again on the following day ; when he was found
quiet, and without any constitutional disturbance. All solid food was
interdicted, and the bowels ordered to be kept open by enemata, and
after the third day there was a gradual but very perceptible improve-
ment, which continued to recovery, in three weeks.

Bayou Sara, March 19, 1853.

VIII.— ON THE USE OF SULPHATE OF QUININE IN TYPHOID

FEVER.

BY R. L. SCRUGGS, M. D., OF LA.

[Extractof a letter addressed to E. D. Fenner, M. D., of New Orleans.*]
I have read carefully your article on " the abortive treatment of fe-
vers by the Sulphate of Quinine— being a reply to the remarks of Dr.
Boling on the use of Quinine in continued fever ;" and while I greatly
admire the tact, skill and talent displayed by you in the argument, I
am compelled to state, that you have totally failed to convince my judg-
ment of the correctness of your position in this most important matter.
In your letter to me, you request me not to criticise your plan without
first giving it a trial ; but I fear I shall never have the boldness to do
this, since it would appear from your writings, that you consider a larger
quantity of Quinine necessary to arrest a mild case of typhoid fever,

* This letter was written in December last, in reply to one from Dr. Fen-
ner, in which he requested me to give him my opinion of his views and argu-
ments upon this subject.

766

The New-Orleans Medical and Surgical Journal.

than would be required to break up the chain of morbid catenations in
cases of pernicious intermittents or remittents. Let me assure you,
however, that long before I ever saw the idea suggested by you, I en-
tertained similar views, and laughed at the idea of permitting any fever
to run its course without an attempt to arrest it with Quinine. This
opinion was based upon " a long and satisfactory use of it," (Quinine)
in the treatment of the worst forms of malarial fevers, and therefore
" it is not probable that the remedy failed to have a fair trial" at my
hands. For some time before I ever saw a case of typhoid fever, I
was in the habit, almost daily, of treating mild cases of remittent fe-
ver, and frequently had to grapple with congestive and typhoid remit-
tents of the most malignant character; and this I had come to do with
an almost entire confidence in the antidotal virtues of the Sulphate of
Quinine. Great, therefore, was my surprise and consternation, when I
found I had mild cases of fever, that not only would not yield to the
Quinine treatment, but became decidedly worse at every repetition of
the dose; and this, too, whether the quantity given was large or small
— whether given alone or in combination with other articles, and in
spite of " all such adjuvant measures with which I was acquainted, cal-
culated to secure its beneficial influence."

I should, in all probability, have destroyed my first case of typhoid
fever, had I not fortunately consulted with an old practitioner, who had
treated the disease in other countries, and become familiar with it. He
told me to stop the Quinine, and not attempt to cure the fever, but to
ward off' the tendency to death by mild and appropriate means — that the
fever would run its course in spite of all treatment, and that any attempt
to cut it short by Quinine would, according to his experience, be much
more certain to cut short the thread of life. But, said I to him, our
fevers here run their course rapidly, and have a strong tendency to ter-
minate speedily in death, unless arrested by the most prompt and ener-
getic treatment. Said he, this is probably a different kind of fever
from any that you have heretofore treated. I replied, that I thought I
had such cases almost daily. To this he answered, your fevers have
been heretofore doubtless of a malarious origin, as is the case in al-
most all newly settled countries ; but as your country becomes older, I
have no doubt but that you will frequently be troubled with a " slow fe-
ver," which has received a variety of names, and has probably pre-
vailed, more or less, in all inhabited countries since the days of Hippo-
crates, and the misfortune is that they so nearly resemble the fevers
which usually precede them, that it is a matter of great difficulty, with
the inexperienced, to diagnosticate between them. But should you be

Dr. Scruggs on Quinine in Typhoid Fever.

767

unable to determine in any other way, there is one way that I think is
infallible, which is this — if you have to deal with a miasmatic fever, of
whatever type soever, your Quinine will always answer your expecta-
tions ; whereas if it be a typhoid (or, as it is sometimes improperly
called, typhus) fever, so far from the Quinine benefitting the case, it
will invariably make it worse. Of course, I do not expect you to be
forced to this alternative after a few opportunities of observation and a
little attention to the subject ; but I merely mention this as a dernier re-
sort, in those cases where certainty in diagnosis is impracticable, either
from the intrinsic difficulties in the case, or from want of sufficient ex-
perience on your part.

The management of more than two hundred cases of this fever since,
extending over a period of eight years, has perfectly satisfied me with
the general correctness of the views of this sage disciple of iEscula-
pius, and I shall ever feel indebted to him for the lesson then taught
me. It was but a short period after this, that deaths occurred in every
direction around us, under the management of physicians who had
previously been successful in the treatment of our endemic fevers ; and
I was called to several large plantations, where deaths had occurred in
quick succession, treated in the ordinary manner with large doses of
Quinine, Calomel and Opium. I immediately changed the whole plan
of treatment — prohibiting the use of Quinine altogether; much to the
astonishment of gentlemen who had come to think, from long experi-
ence, that it was madness to attempt the cure of a bad case of fever
without the use of this great febrifuge ; but I had the satisfaction of see-
ing the worst cases yield handsomely to the treatment instituted, and
thus demonstrated to their entire satisfaction that the disease could be
cured, or at least conducted to a favorable termination, without the use
of any anti-periodic agent whatever.

I am thoroughly convinced, from my own observations and a good
deal of reading, that it does not belong to the class of miasmatic fevers ;
and I am equally well convinced that it is not typhus. I object to the
term continued fever as applied to this dlisease, because other fevers
are equally continued; and indeed I am not altogether satisfied with the
term fever ; for the reason, that in a few cases, at least, what has been
assumed as an essential character of fever, to wit, frequency of pulse,
is altogether wanting. These latter cases certainly are the true ty-
phoid affection ; first, because they have all the other symptoms char-
acteristic of the disease ; and secondly, may, by inappropriate treat-

708 The New-Orleans Medical and Surgical Journal,

ment, be converted into cases of the greatest severity, which they ar©
not liable to become if managed gently and appropriately.

Again, I am satisfied that some of the most distinguished teachers
of England and Ireland have failed to make the proper distinction be-
tween typhoid and typhus. For instance, Prof. Graves, in his clinical
lectures, calls the attention of his class to the fact, that all the fever
cases brought from the country to the Dublin hospitals, have tympanitis.,
gurgling, frequent discharges from the bowels, etc., and this he attri-
butes to ignorance on the part of country physicians, who have had the
treatment of these cases at the beginning.

Would it not have been more philosophic in the learned Professor,
seeing that these symptoms were invariably present in the country
cases, to have concluded that those cases which originated in the open
country were different in their nature from those produced by the idio-
miasmata of the jails, hospitals, and crowded and filthy apartments of
the city of Dublin, than to have accounted for the difference of symp-
toms by supposing that the physicians were ignorant of the proper
treatment ? the country physicians of Ireland being, I presume, as well
instructed generally as country physicians elsewhere ; and this view of
the subject is confirmed by the observations of many of the most en-
lightened men of our profession, both in Europe and in this country.

As for the treatment best adapted to this disease, I have only to say,
that the plan adopted by me in Tennessee, and pursued in this State
for the past three years, has been so entirely successful, that I have had
but little occasion to alter or modify it. If I have made any alteration
at all, it consists in giving less medicine, making a little freer use of
ice, and relying more upon the recuperative energies of nature. Ad-
ditional experience has confirmed the high opinion I formerly enter-
tained of the peculiar virtues of the oil of turpentine in the ulcerative
stage of the glands of Peyer, and induced me to reject, almost entirely,
every other stimulant. I use opiates, but never in the beginning, nor
for many days, and then with the greatest possible caution, having had
repeated opportunities of witnessing their ill effects upon the brain in
this fever.

Brandy and wine I very rarely use at all, although I have sometimes
resorted to them with benefit in the latter stages of severe cases, along
with beef tea, animal jellies, infusion of bark, etc.

Dr. Dundas' plan has been recently tried by several prominent phy-
sicians of England and Scotland, and you know the result. In no in-
stance did the Quinine benefit the patient, and in several it was produc-

Dr. Scruggs on Quinine in Typhoid Fever.

769

tive of very alarming effects. My experience is, that Quinine is never
productive of good in these cases, will always produce distressing head
symptoms, will frequently convert a mild into a severe or dangerous
case, and sometimes (particularly when given in large quantities) cause
death.

I was not a little surprised to see how lightly you regard a knowledge
of the intestinal lesions peculiar to this disease, as manifested in the
following sentence in your review of Prof. Austin Flint's Clinical Re-
ports : " Now, with due deference to this respected author, we must
contend that this is a matter of no importance whatever. What do we
care for the characteristic anatomical lesion of typhoid j ever, or any
other disease, if a knowledge of it suggests nothing beneficial either
in its prevention or cure."

But, my dear sir, let me ask, does not a knowledge of the characteristic
anatomical lesions in disease always suggest, to the intelligent physi-
cian, something valuable? This is certainly the doctrine of the schools,
and I should be exceedingly sorry to be convinced, at this late day, that
it was erroneous. Even when, by a knowledge of the character and
extent of the lesions, we are enabled to pronounce positively that the
case is hopeless, still this knowledge is frequently valuable, both to
physician and patient ; for it prevents the one from making an incor-
rect prognosis, causes him to study the euthanasia, as in duty bound
in all such unfortunate circumstances ; and enables the other to make
preparation for the fatal event.

But this is not all ; I am well satisfied, from my own observations,
that disease of these glands commences with the fever, if it doos not
precede it. I am not prepared to assert that it is the sole cause of the
fever ; other causes may, and probably do act along with it ; but of one
thing I am very positive, to wit, that appropriate treatment addressed
specially to the diseased glands tends powerfully to meliorate the con-
dition of the patient, by lessening the virulence of the fever ; and I be-
lieve also, frequently shortens its duration. I helieve with Professor
Wood, that " the intestinal affection is as characteristic of this dis-
ease as the eruption is of small-pox,'' and it is not unreasonable to
conclude that this inflammation of the glands may, under favorable cir-
cumstances and proper treatment, terminate in resolution. Nor does
the fact that a few cases die suddenly and unexpectedly, in my opinion,
militate against the theory, that the severity of the symptoms and gravity
of the case is in proportion to the extent and severity of the intestinal
lesions, for this may be accounted for in the following manner. A per-
son who has tubercular or other disease of the mesenteric glands is

770

The New-Orleans Medical and Surgical Journal.

taken with typhoid fever, one of these diseased mesenteric glands is in
contact with the bowel, and pressing injuriously against it, directly op-
posite one of the inflamed glands of Peyer ; this being the case, we
can very readily understand how the two causes, acting together, might
easily produce perforation at that point, without there being any symp-
toms previously, to indicate the danger of the patient. I lost a stru-
mous patient in 1851, who, after convalescence had commenced, was
taken suddenly with symptoms of perforation of the bowel, and died in
a few hours ; and whether right or wrong, this was my explanation of
the matter.

The word "typhoid" seems to be a great stumbling-block in the way
of some physicians, it being sometimes used as a generic term to de-
note a class of diseases sui generis ; and at other times adjectively, to
express that condition of the system which so frequently supervenes
in protracted cases of acute disease. This is certainly calculated to
produce some degree of confusion in the minds of medical students ; but
it does appear to me that it ought not, with experienced and reading
physicians, particularly when it is recollected that this explanation is
made in every systematic treatise on the subject.

This typhoid condition of badly treated and protracted cases of bili-
ous remittent fever has undoubtedly often been mistaken for the disease
in question, and that too by physicians of considerable reputation. This
was evidently the case, to my mind, in the instances related by your
distinguished friend, Dr. Fearn, as having occurred in North Alabama
in 1832. I have seen many such myself, and think that I am able,
generally, to distinguish between them and true typhoid fever. I was
. called in consultation to just such a case not long since, and unhesitat-
ingly advised Quin. grs. x, Acet. Morph. gr. i. Ipecac, gr. §. This
was given, and repeated pro re nata, and the patient had no return of
fever and rapidly recovered,

I never give more than twenty grains of Quinine at a dose in any
fever ; and more generally than otherwise, five grains is the dose pre-
scribed by me— -to be repeated every hour or every two hours until 25
to 40 or 50 grains are taken. I never give more than this, because
experience has proven to my satisfaction that this quantity is amply suf-
ficient, and both reason and experience teach me that more than enough
is likely to do harm, cannot possibly do good, and is, furthermore, a
foolish waste of a costly medicine.

You will perceive, from what I have said,, that the diagnosis between
t ese two diseases is, in my judgment, of the last importance ; as a

Dr. Seuggs on Quinine in Typhoid Fever.

Ill

failure to give the necessary quantity of Quinine at the proper time, in
a severe case of miasmatic fever, would be to permit the patient to die
for the want of the appropriate remedy ; whereas the administration of
it in a case of genuine typhoid fever, would be directly to bring about
the disastrous result, by the administration of a poison in that disease*

Pardon me for entertaining and expressing the belief, that you place
much too high an estimate upon the opinions of a man who, although
he may have been a skillful physician in his day, yet, for reasons best
known to himself, forsook the honorable profession selected by him in
his youth, for the more lucrative, but certainly not more intellectual oc-
cupation of a merchant ; and who probably has not exercised his mind
in the investigation of a case of disease for many years past. I cer-
tainly think that such testimony will not, nor ought not, to be relied
upon, in opposition to that adduced by such men as Dr. Wm, M. Boling
of Alabama, Doctors Gerhard, Wood, Bartlett, and a host of minor wor-
thies, North, South, East and West — men, whose sole aim is to learn
to treat disease correctly, and the business of whose lives consists in
the study and investigation of the various phenomena produced upon
the human body by " the thousand ills that flesh is heir to.''

Had your distinguished friend practised the profession of medicine in
North Alabama up to the present time, and now given his peculiar
views as the result of extended experience, I should think his opinions
upon this or any other subject connected with our profession, entitled to
the highest respect ; but under the circumstances, I consider them of no
value whatever.

In conclusion, permit me to venture the prediction, that should you
ever have a. fair opportunity of thoroughly investigating this interesting
subject, your opinions will undergo a complete revolution in regard to
its causes, pathology, treatment, etc. You had not this opportunity,
neither at Jackson, Tennessee, nor Clinton, Mississippi ; for you left
both places before this disease had made its appearance at either; nor
do I think it probable that you will ever have the opportunity presented
to you in New Orleans, for the reason that the proportion of typhoid to
the other fever cases, is too small in that great paludal city to enable
you to judge correctly between them.

772 The New-Orleans Medical and Surgical Journal

IX.— OESARIAN OPERATION IN A WELL FORMED PELVIC.

BY B. HARVEY, M. D., MISS.

A. Hester, M. D.

Sir — 'The following sketch is at your disposal, if it should bethought
worthy of a place in your valuable Journal.

In July, 1849, I was requested by Mr. John Morrow to visit his ser-
vant Easter, who was about to accomplish the gestation of her eighth
child. She had been in labor several hours ; pains strong and regu-
lar. I made a per vaginam examination, without being able to reach the
os uteri. An examination, externally, led to the discovery of an im-
mense ventral hernia. The changes wrought upon the tumor during
the pains, together with the fact first stated, forbade a doubt as to the
nature of the Case.

What was to be done 1 Here was an enormous pear-shaped tumor,
with a pedicle so small as to preclude a possibility of delivery per vias
naturales.

Determining at once upon the necessity of the knife, but unwilling
to take upon myself the responsibility of so grave a measure, I admin-
istered a large anodyne, and requested an interview with Dr. Saml.
Sample, (a gentleman of high professional standing) who unhesitatingly
concurred with me in the propriety and necessity of the Caesarian
operation.

Without detailing the particular steps in the operation, it is sufficient
to state, that in the presence, and by the assistance of Doctors Sam-
ple, Harrington and Tackett, it was performed in the manner usually
recommended, without any thing occurring worthy of special re-
mark.

The foetus was in a state of asphyxia, but was soon revived. The
uterus, when emptied, contracted well. The wound was dressed in the
usual way.

The child was taken from home and placed in a negro-quarter}
where it died in about eight or ten days, probably from want of proper
attention.

The mother died at the end of three weeks, from irritative fever,
as I learned from the attending Physicians, Doctors Foster and Har-
rington.

Harvey on the Casarian Operation,

773

It may be proper for me to add, that about two years previous to the
above history, this woman suffered a rupture of the uterus, and Dr.
John Tackett being called, determined upon Gastrotomy, (as affording
the only hope for mother or child) which he performed with his usual
skill.

The woman's last misfortune was owing, I presume, to the peritoneum
failing to unite after the last mentioned operation.
Richland, Holmes Co. Miss., March 23, 1853.

100

J? art 0£con&«

EXCERPT A.

I. — Contributions to the Pathology of the Heart.

BY DR. M'DOWELL,

The following observations are derived from an analysis of numerous case^
of cardiac disease treated by the writer in hospital practice during the last few
years, and which were carefully recorded as they severally came under his
observation.

It is not the object of this communication to enter upon the subject of heart
disease in general, but rather to direct attention to the records of some cases
which present in themselves peculiar features, and to allude to such general
matters only, relating to the pathology and diagnosis of cardiac disease, as
the writer feels that he is enabled to accomplish by the materials which are
at his disposal.

Were the differential diagnosis and pathology of cardiac diseases clearly
established, such a communication as the present might be well deemed super-
fluous, but as our knowledge of this class of diseases is comparatively recent,
and as yet imperfect, it seems desirable, as opportunities occur, to advance
that knowledge by the results of clinical observation.

Organic diseases of the heart have been considered under two heads, as
they engage—

1. Its valvular structure.

2. Its muscular tissue.

This classification has been found no less useful in practice than convenient
in the study of morbid appearances. True it is that lesions of both structures
often co-exist, or even spring up together; but, on the other hand, in many
instances they exist separately, or even where combined they not unfrequently
hold to each other the relation of cause and effect.

The valvular diseases of the heart have received by far the largest share of
attention, and hence they are by many too exclusively regarded as the sole
cause, both of the symptoms and of the fatal result. Yet the morbid changes
which affect the muscular tissue of the heart are no less deserving of our at-
tention, as they assist us to explain the laws which regulate the fatality of
heart diseases, as well as to understand better the differential characters of
these affections.

Excerpta.

775

At the present day it is comparatively easy to distinguish the several valvu-
lar diseases from each other- The chief difficulty seems to be in establishing
the differential diagnosis in certain cases, between organic and non-organic
diseases ; and again, in cases of organic disease, in discriminating those in
which there is valvular lesion from others, in which, with healthy valves, the
muscular tissue and cavities of the heart have undergone morbid changes. To
illustrate some of the structural changes which belong to this latter class is
the principal object of the present communication.

CASE I.

Mary Byrne, aged 33, was admitted into the Whitworth Hospital under my
care, October 12, 1846. She states that she has labored under some of the
symptoms of the disease of the heart for the last fifteen months; palpitation
was first complained of. Five weeks later she had an attack of hemoptysis,
which continued for two days. Six weeks prior to her admission into the hos-
pital, dropsical effusions became developed ; her face and ankles first swelled,
and subsequently the abdomen. She never at any time labored under rheu-
matism. On her admission general anasarca and ascites, to a slight extent,
were present ; extreme distension of the legs by serous effusion rendered her
very helpless ; while a frequent harassing cough, with scanty expectoration,
increased much her sufferings ; there was extreme dyspnoea occurring in par-
oxysms, and amounting to orthopncea ; the face was bloated, and so darkly
congested as to be almost livid ; the superficial veins of the neck were turgid,
whilst the extremities were constantly cold and mottled. The urine was
small in quantity and high-colored, specific gravity 1016, not containing albu-
men. The digestive organs were much deranged.

The chest generally yielded a dull sound, owing to anasarca of its parietes ;
cardiac region extensively dull ; heart's impulse weak, as contrasted with the
apparent amount of cardiac enlargement ; heart's action extremelv irregular ;
second cardiac sound normal and distinct, whilst the first sound was accom-
panied or replaced by an evident murmur, heard most loudly over the heart's
apex, but lost along the sternum. No fremissement. Radial pulse extremely
small, weak and intermittent, 108 in the minute. The signs of universal bron
chitis, with pulmonary congestion, were present.

No treatment could be expected to have much influence under such unfavor-
able circumstances. Diuretics, purgatives and diffusible stimulants were em-
ployed with some benefit; subsequently blue pill in minute doses, with digita-
lis and squills, was prescribed. On the 21st it was reported that much relief
had been experienced, but all improvement ceased here, and her most unfavor-
able symptoms became more developed. With increasing dropsy there was
increased dyspnoea, and death was impending from apnoea, when coma suddenly
set in, and she died November 4th.

Post-mortem Examination. — The lungs were gorged with blood, but were
not structurally altered ; the cavitv of each pleura contained about eight ounces
of straw colored serum ; the pericardial cavity about half an ounce only. The
heart was greatly enlarged ; when washed out it weighed thirteen ounces ; the
left ventricle was extremely dilated ; its walls were not hypertrophied, and
therefore bore no proportion to the size of the cavity ; dilatation was the pre-
dominant change, and hence the size and weight of the heart were not duly
proportional, as they must be when hypertrophy predominates. The carneae
columnae of the mitral valve were considerably enlarged ; the mitral valve
itself was healthy, except a small cartilaginous nodule, not larger than a grain
of small shot, on its anterior flap ; the left auriculo-ventricular opening was
somewhat dilated, and consequently the normal relation as to size between the

776 The New-Orleans Medical and Surgical Journal.

opening and its valve no longer existed; the left auricle was also more capaci-
ous than usual ; the sigmoid valves of the aorta, the lining membrane of that
vessel, and the valves of the right side of the heart, were perfectly healthy.
The same changes were found in the right cavities, but in a much slighter de-
gree. The substance of the heart itself was altered in appearance "and con-
sistence; its fibres were paler than usual, being of a yellowish brown color,
whilst their cohesion was diminished; the muscular tissue was manifestly sof-
tened. The liver and kidneys were engorged, but were otherwise healthy.

CASE II.

Isabella St. John, aged 63, admitted into the Whitworth Hospital under my
care, December 11, 1847. On admission, in this case as in the preceding one,
the symptoms were essentially those which are usually attributed to obstructive
disease. In addition to palpitations, distressing dyspnoea, and breathlessness,
the usual accompaniment of confirmed cardiac disease, lividity of the face, re-
markable turgescence of the jugular veins, and anasarca to an extreme degree,
were present, and evidently pointed to an obstructed circulation. The symp-
toms of cardiac disease had first appeared a year previously, and since then
had gradually appeared more developed. Dropsy had been but lately super-
added ; she had never had rheumatism in any form ; hemoptysis had occurred
on more than one occasion. The cardiac signs consisted in considerable in-
crease of the natural amount of dullness, a bruit at the apex with the first
sound, a faint impulse, and an irregularly acting heart. The radial pulse was
equally intermittent with the heart, and extremely weak,

It is unnecessary to follow this case through all its details from day to day.
The distressing symptoms which have been enumerated admitted of no benefit
from treatment. The dyspnce increased, whilst the limbs continued to enlarge,
until at last they became enormously distended. The circulation then grew
more languid, and livid vesicles appeared on the legs as the forerunners of
gangrene, when death put a period to her sufferings.

Post-mortem Examination. — The body was of great size from serous infil-
tration, as also from an excessive deposit of tat. The heart was large, flabby
and softened. Its left cavities were very much enlarged, without any increase
in the thickness of their walls. The left-auriculo-ventricular opening was re-
markably dilated, and allowed five fingers to pass with ease. The venous sys-
tem was universally gorged with blood, which was yet fluid, but presented no
traces of any admixture with oil. The valves, without exception, were per-
fectly healthy.

In the two cases which have now been detailed, the cardiac lesions were es-
sentially the same. In both there was an enlarged, softened and dilated heart,
with ventricles so much expanded, that their cavities had become dispropor-
tioned to their propelling power. These changes occurred independently of
any valvular disease ; for in case I., the small spot of thickening, no larger
than a grain of shot, cannot be considered to have interfered with the functions
of the mitral valve. The left auriculo-ventricular opening in both instances
was dilated, so that although the mitral valve was perfect in point of structure,
it was, nevertheless, quite inadequate to guard an orifice, dilated, as in case II.,
to at least twice its usual dimensions. In both cases, consequently, there was
regurgitation through the left auriculo-ventricular opening, of which the bruit
heard over the apex of the heart was significant, and a languid systemic, toge-
ther with an obstructed pulmonar7 circulation. Hence, in obedience to a well
known law, that morbid changes in the heart are propagated in a direction
contrary to the circulation, there resulted engorgement of the lungs, enlarge-

Excerpta.

Ill

ment of the left cavities of the heart, venous obstruction and plethora, and
lastly general dropsy. As hepatic obstruction was but a part of the obstruction
of the general circulation, we find that ascites occurred subsequently to ana-
sarca, and existed to a comparatively slight degree. The prominent symptoms
in these two cases were in all material points the same ; they were also almost
identical with those which characterize a contracted condition of the left auri-
culo-ventricular opening.

The following arrangement enables us to compare advantageously the prom-
inent symptoms observed in cases I. and II., with those which denote left au-
riculo-ventricular contraction :

Contraction of the left auriculo-ventri-
cular opening.

An irregularly acting heart.

An intermittent, feebJe,and rapid pulse,
not synchronous with the heart's im-
pulse.

Dyspnoea, hemoptysis and pulmonary

congestion.
Jugular pulsation and turgescence.
Cerebral symptoms.
General dropsy.
Jaundice (occasionally).

Passive dilatation of the ventricles;
softening of the heart.

CASES i. & II.
An irregularly acting heart.
An intermittent, feeble and rapid pulse.

Dyspnoea, hemoptysis and pulmonary

congestion.
Jugular turgescence.
Death by coma in case I.
General dropsy.
Jaundice (not observed).

It is to be observed that the want of correspondence between the heart's ac-
tion and the radial pulse, a symptom so much insisted on by Mr. Adams in
contraction of the left auriculo-ventricular opening, did not exist in the cases
of dilated ventricles, whilst the strong impulse of the heart in the former af-
fection contrasts remarkably with the feebleness of its action in the latter
case.

Were the first mentioned sign (want of synchronism between the impulse of
the heart and the radial pulse) an invariable, and therefore a pathognomonic
sign of a contracted mitral opening, the elements for establishing a differential
diagnosis might be therein found, but it has occurred to the writer to meet with
several cases in which this symptom was wholly wanting, and yet mitral con-
traction was proved to have existed on examination after death.* Probably it

* A brief abstract is here given of three eases in which the pulse was regular,
and synchronous with the heart's impulse, whilst on examhation after death, mitral
narrowing was proved to have existed.

I. Celia Long, aged 30, a patient of mine in the Whitworth Hospital, died Jan-
28th, 1848. Cardiac disease supervened on rheumatism. Symptoms during life : A
very small and rapid but regular pulse ; disproportionately strong action of the heart;
bronchitis ; dropsy.

Autopsy. The left auriculo-ventricular opening was so contracted as to admit
the entrance of the little finger only ; the mitral valve was opaque and rigid ; the
left auricle was greatly dilated and hypertrophied ; the aortic orifice was likewise
contracted.

II. John Casey, aged nineteen. Whitworth Hospital. Died January 25th, 1850.
Never had rheumatism. Symptoms during life : Dyspnoea, bronchitis, hemoptysis,
pulse small but regular; wild delirium occurred suddenly on the 24th, followed
by profuse hemoptysis, which continued for about twenty-four hours, when death
occurred.

778 The New-Orleans Medical and Surgical Journal.

may be a constant symptom in the advanced stages of the disease, when the
narrowing has become so great, that the ventricle sometimes contracts on an
almost empty cavity.

The disproportion between the force of the heart's action and that of the ra-
dial pulse is more valuable, because it is a more constant indication of con-
tracted mitral orifice. But apart from other symptoms, this cannot be regarded
as a diagnostic sign, since it may be present under other and different morbid
conditions.

The difficulty of distinguishing between these affections will be further in-
creased when it is considered, that the other symptoms which have been in the
table assigned to contraction of the mitral orifice, are not necessarily connected
with this condition exclusively. For example, hemoptysis may depend on
passive dilatation without softening, or on aortic patency and dilatation. Jugu-
lar turgescence indicates engorgement of the right side of the heart; jugular
pulsation, regurgitation through the right auriculo-ventricular opening ; and
these phenomena denote mitral contraction only, inasmuch as that lesion gen-
erally produced those changes in the right cavities of the heart on which" the
symptoms in question depend. Cerebral symptoms have been very generally
referred to a contracted condition of the left auriculo-ventricular opening. No
doubt apoplectic seizures do often occur in the course of this disease, and not
{infrequently prove the immediate cause of the fatal result. But at the same
time, cerebral lesions may take place in any morbid condition of the heart that
enfeebles the general or systemic circulation. The apopletic death of case I.
has already illustrated this point. Neither does jaundice essentially belong to
mitral contraction ; and besides, contrary to what might a 'priori be expected,
jaundice so rarely depends on heart disease, that its occasional development
can scarcely be considered of any great weight as an element of diag-
nosis.

If these remarks have conveyed the impression that the symptoms of pas-
sive dilatation with softening of the heart may be readily confounded with
those of contraction of the mitral orifice, the signs furnished by auscultation
and percussion in these two classes of cases will scarcely clear up the dffi-
culty. These signs are very similar in both classes. In cases I. and II. there
was detected by percussion an enlarged heart, whilst by auscultation a bellows
murmur was revealed over the region of the apex, systolic as to the time of
its occurrence, and single. Similar are the phenomena which are generally
met with in practice, or described by authors, as associated with contraction of
the left auriculo-ventricular opening.

It is stated by some authorities, that in mitral contraction a double bruit may
be heard, one murmur being produced by the obstacle in the way of the blood
entering the ventricle, the other by its subsequent regurgitation. The writer
has never verified this observation, although he has examined a great many
cases with reference to this particular point. It has occurred to him, and not

Autopsy. Mitral valve rigid from bony deposits, opening contracted, and with
the valve representing a bony thimble, terminating inferiorly in a narrow chink, al-
though admitting the point of the finger superiorly ; the left ventricle was the only
part of the heart which retained its natural appearance ; the other cavities were all
very much dilated ; the walls of the left auricle were immensely thickened. The
lungs were gorged with fluid blood.

III. Jane Carroll, aged 1 6. Whitworth Hospital. September 16th, 1846. Had
acute rheumatism one year previously. Symptoms : Anasarca, bronchitis, frequent
hemoptysis, livid lips ; pulse 120, very small but regular ; contraction of the mitral
valve was diagnosed. Six months afterwards she died in Dr. Bank's ward, and on
an examination at the autopsy, a contracted condition of the mitral opening was
found to exist.

Excerpta.

779

unfrequently, to meet with cases in which a double bruit was audible at the
apex of the heart ; but in all of them he could satisfy himself that one of the
murmurs, to say the least, was propagated thither from some adjoining lo-
cality.

Whilst the physical signs just enumerated are those which usually indicate
mitral contraction, it must be clearly understood that their absence does not
necessarily indicate valvular soundness. In many cases of mitral contraction,
no abnormal sound whatever indicates the lesion, and the diagnosis must then
rest on general symptoms. The presence or absence of bruit does not appear
to the writer to depend on the extent to which mitral contraction has advan-
ced, as do the other symptoms. The bruit is chiefly due to regurgitation from
the left ventricle into the right auricle. And as contraction of the orifice may
occur without any impairment of the functions of the mitral valve, there may
be obstruction and no regurgitation. In such cases there will consequently
be no bruit. This was observed in another case.*

Mitral narrowing, it would thus appear, may occur under at least two forms.
In one, the morbid change affects the orifice chiefly, which is then reduced
more or less in size, until it represents a " semilunar fissure," with the con-
cavity turned towards the aorta. In the other, the valve is likewise engaged,
and becomes puckered, thickened and shortened, whilst the opening is con-
tracted; and not unfrequently both opening and valve are converted into an
appearance like that of a bony thimble, the point projecting into the ventricle,
and presenting a small, unyielding aperture, which not only obstructs the en-
trance of the blood, but allows of its partial regurgitation. But another cir-
cumstance may influence the existence or absence of bruit in mitral narrow-
ing, viz., the amount of regurgitation.

In those cases of valvular imperfection, in which a considerable amount of
fluid is transmitted with force through an altered opening, the murmur which
results is always well developed, as, for example, the diastolic murmur of aor-
tic patency, and the prolonged systolic murmur which accompanies mitral in-
adequacy. Where contraction of the left auriculo-ventricular opening is es-
tablished, the tendency of the disease is to diminish the amount of blood enter-
ing the left ventricle, and in an equal degree the amount and force of its re-
gurgitation into the left auricle, where the lesion is such as to admit of regur-
gitation. Now this cause operates more and more, as the narrowing goes on,
until finally, when the opening is so much diminished that the ventricle can
only get a "precarious supply of food" (Adams) the amount of regurgitation
must be extremely small, or perhaps only occasional. In accordance with these
views, it is in the advanced stage of mitral contraction that a bruit is most
frequently wanting f

* As this case will not appear in the present paper, the following brief abstract
of the morbid appearances is here introduced, in order to preserve the connexion of
the subject.

Catherine Leonard, aged 40. Contraction of the left auriculo-veutricular opening.
Admitted November 5th, 1851.

Post-mortem examination, November 21st. Heart much enlarged, the right cavi-
ties greatly increased in size; in the left chambers hypertrophy predominated ; the
left auriculo-ventricular opening was considerably diminished in size ; but the leaves
of the mitral valve were unaltered, and consequently quite capable of performing
their functions.

t Mr. O'Ferrall has clearly shown that the progress of mitral contraction may
cause the disappearance of an originally well-developed murmur. He explains this
occurrence by supposing that the shortened valve becomes again adequate to its task
in consequence of progressive contraction.

780

The New-Orleans Medical and Surgical Journal.

It would appear, therefore, from the details of these cases, (I. and II.) that
passive dilatation of the ventricles of the heart (with which dilatation of the
left auriculo-ventricular opening is generally associated) and softening of
their muscular walls, will be attended with a group of symptoms and of physi-
cal signs which are almost identical with those which usually denote a con-
tracted condition of the left auriculo-ventricular opening.

[Dublin Quarterly Journal

( To be continued.)

II.— On the Hemostatic effects of the Eau Pagliari

BY PROF. SED1LLOT.

The formula for the preparation of the styptic water, invented by Signor
Pagliari, an apothecary at Rome, and which has attained a high celebrity on
the Continent, is thus given by Prof. Sedillot, to whom it was transmitted by
the inventor.

Take of benzoin eight ounces ; sulphate of alumina and potassa one pound;
water ten pounds. Boil together in a glazed earthen vessel for six hours, con-
stantly stirring the resinous mass, and supplying the mass by evaporation by
successive additions of hot water, so as not to interrupt the ebullition. Finally
filter the liquid, and preserve it in well stopped glass vessels. The portion of
benzoin which remains undissolved will be found to have lost its odor and in-
flammability.

The hemostatic water thus obtained is limpid, resembles champagne in color'
has a slightly styptic taste, and a sweetly aromatic odor. It leaves, on evapo-
ration, a transparent deposit, which adheres to the side of the vessel.

The following are the conclusions deduced by M. Sedillot from his experi"
ence of this and other styptics :

1. There are fluids which instantaneously coagulate the blood, and convert
it into a thick, homogeneous and consistent clot.

2. The eau Pagliari enjoys this remarkable property, and does not exercise
any injurious action on the tissues with which it comes in contact.

3. Theory, experience and clinical observation equally concur in demonstrat-
ing its efficacy as a styptic.

4. The object of compression, in the application of hemostatic liquids, is to
permit the coagulation of the blood, as well as the adhesion of the clot to the
mouths of the wounded vessels.

5. In all cases in which recourse cannot, without serious inconvenienee, be
had to ligature, as well as in those in which the alteration of the blood prevents
its coagulation, and renders hemorrhage dangerous, the eau Pagliari may be
advantageously employed, and deserves to be classed among the valuable re-
sources of our art.

( Gazette Medicale de Strasbourg.)

Excerpta,

731

III. — The Laws regulating the Bodily Temperature and the frequency of the

Pulse.

BY R- LICHENFELS AND E. FROLICH.

The authors have made a most careful series of experiments on themselves.
Each experimenter is twenty-two years of age ; the pulse of one of them is
normally 71 per minute, that of the other 88 ; the normal temperature of each
is 98.434. During the course of the experiments, they rose shortly before seven
o'clock, A. M., took coffee between 7 and 8, had dinner at 2, and evening coffee
between 7 and 8.

1. Daily rate of pulse and temperature. The influence of the period of the
day, per se, was very trifling, but both pulse and temperature were greatly af-
fected by food. Before the morning coffee the pulse was lowest ; by the end
of the first hour after coffee it rose, on an average of many observations, nearly
8 beats per minute ; it was slightly less rapid at the end of the next hour ; at
the end of the third hour it was only 3-3 beats ; and at the end of the fourth,
2.77 beats over the original number. The pulse did not sink to the number
noted before coffee, till six hours had elapsed- The mid-day meal raised the
pulse again, and this occurred apparently sooner after protein than after starchy
food, but to a less extent. After the evening coffee, the pulse, which had fal-
len, again rose, but to a less extent, and its declension occurred much more
rapidly.

The temperature of the body was affected in a similar way by food, but the
augmentation occurred later than the rising of the pulse ; so that the tempera-
ture was often at its maximum when the pulse had fallen considerably towards
the point from which it had risen. The average amount of increase is about
one third of Fahrenheit. The greatest average range of the thermometer in
the course of the day, (between 7 o'clock, A. M., and 10 P. M.) was rather less
than a degree.

2. Influence of customary liquid. The experiments were performed in the
afternoon ; each lasted one hundred minutes, and the greatest tranquility of
body was preserved. After beer, the pulse sank 6 or 7 beats in from 10 to 15
minutes ; in 30 minutes it gained its former frequency ; much before this time
the subjective feelings of slight incipient intoxication were felt. In about two
hours the pulse was heightened nearly double as much as it had been depressed.
The temperature, after the use of beer, fell about one third of a degree of Fah.
After wine, the pulse at first fell in the same way, and then rose greatly ; the
temperature fell about half a degree of Fah. The same occurred with alco-
hol, but afterwards the temperature rose about a quarter or half of a degree of
Fah. Cold water lessened, at first, the number of the pulse, and lowered the
temperature. In about fifteen minutes both returned to their former amount.
Coffee, as already said, raised the pulse, but more in the morning than in the
evening.

3. Influence of fasting. Fasting for from 20 to 21 hours, lowered both pulse
and temperature. At the end, the pulse was from 12 to 16 per minute ; the
temperature as much as 1-8 degree Fah., under the normal. The curious
observation (which was likewise made by Davy and Gierse) was noted, that
at the period of customary meal times, both the pulse and temperature slightly
rose.

4. Influence of muscular movements. Various experiments were tried with
different kinds of movements :

First. A ten-pound weight was allowed to hang from the arm for five min-
utes, the body being tranquil ; the pulse first fell in frequency, then rose ; its

101

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The New-Orleans Medical and Surgical Journal.

greatest frequency was after the termination of the experiment. When the
weight was on the left arm, the rise was nearly double that which occurred
when it was on the right arm.

Second. A weight of one pound was held out horizontally ; the pulse rose
and fell remarkably several times.

Third. A weight of two pounds was rapidly swung round and round with
one arm, while the other was placed on a table, that the pulse might be counted.
This exercise produced the greatest effect on the pulse, raising it sometimes
from 30 to 50 beats.

Fourth. Long-continued moderate exercise, carried on to fatigue, raised the
pulse greatly for some time, but never produced the enormous rise noticed in the
previous kind (third) of muscular exertion.

5. Influence of narcotic poisons. Belladonna and atropine at first diminished
the frequency of the pulse (16 to 20 beats) but after a variable time (15 to 117
minutes) the pulse again rose (12 to 30 beats). The smaller doses produced
greater primary sinking than the large, but required much longer time to do so;
on the contrary, the larger doses produced much greater secondary rising; that
is to say, the maximum sinking point is inversely, and the maximum rising
point is directly, proportioned to the amount of the drug. It might be said that
small doses depress, larger excite, the pulse.

The temperature was diminished in all cases. Opium, especially in small
doses, caused the rising of the pulse, but afterwards there was great sinking,
and the temperature diminished.

The Cannabis Indica produced many periods of rising and falling ; the tem-
perature rose for about four hours, and to as great a degree as 7 or 8 degrees
Fah. Chloroform and ether, if not pushed to too deep narcotism, raised both
temperature and pulse.

{British and For. Med. Chirurg. Rev.)

IV .-r- Contributions to the Pathological Physiology of Pneumonia.

BY DR. G. ZIMMERMANN.

Zimmermann considers the most minute observation of the natural course
of acute disease, to be the only way of elucidating the laws of these typical
processes. Although he thinks those cases most fit for the purpose in which
no remedies are employed, yet he does net at all exclude those in which the
treatment is active. As an instance of how to observe, he describes the course
of a case of pleuro-pneumonia, treated by repeated venesection, application of
blisters, and internal administration of antiphlogistic remedies, in moderate
doses. From the first day of the fully established disease, till after the return
of convalescence, he has noted twice daily (at 8 A. M., as the time of remis-
sion, and between 5 and 6 P. M., as the time of exacerbation) the temperature
under the tongue, the frequency and other qualities of the pulse, and the num-
ber of inspirations on almost every day, the quantity of urine secreted in twenty-
four hours, its specific gravity, and the quantity of lithic and acid contained in
it. Of great interest are the critical symptoms, remarked on the third and then
again on the ninth day, after which we observe a steady progress to convales-
cence. The first note on the temperature was taken four hours after an attack
of general vehement rigors, which the patient himself considered as the com-
mencement of the disease; it was then as high as 103 deg. 1, which being 4

Excerpta. 788

deg. 14 over the normal warmth of that individual (98 deg. 96) makes Zimmer-
man inclined to conclude that the disease had commenced before the occurrence
of the rigors. Between the evening of the second and the morning of the
third day, a decrease from 104 to 99 deg. 86, was observed, coincident with a
general abatement of the constitutional symptoms of pyrexia, but on the eve-
ning of the third day the temperature was again as high as 105 deg. 80, and
the physical examination exhibited the signs of hepatization, which had not
been present in the morning. Between the evening of the eighth and the morn-
ing of the ninth day, the warmth had decreased from 106 deg. 16 to 99 deg.50;
at the same time all the other febrile symptoms disappeared almost completely,
after they had reached a very high degree on the two previous days. It is in-
teresting to remark, that although the frequency of the pulse did not exceed the
normal average after that period, yet the temperature increased again to 102
decrees 20, and remained so for more than a fortnight longer. The entrance of
the change on the ninth day does not appear to Zimmermann as merely acciden-
tal, but he looks at this day as a critical one ; and also the coincidence of sev-
eral alvine evacuations effected by calomel, seems important to him, as he thinks
that the crisis may be promoted by our remedies, if their action takes place
shortly before or on the beginning of a critical day. Concerning the urine, the
quantity secreted in twenty-four hours was between 90.40 and 29.030 grains ;
the minimum is noted on the fifth, the maximum on the ninth day; the average
quantity of twenty-four hours before the tenth day was 15.215 grains, with an
average specific gravity of 1.0198; between the tenth and the fortieth day
16.510 grains, with 1.0208 specific gravity. The quantitative examination for
urea was not made before the eighth day, on which 1081 grains were contained
in the urine in twenty-four hours ; on the ninth day, only 884 grains ; and a
few days later not more than 400 grains, (which is about the average quantity
during health— Lehmann, Physiol. Chemistry, volume i. page 167). The quan-
tity of uric acid was almost normal during the commencement of the disease,
but after the sixth day it appeared considerably increased, and reached the max-
imum on the nint'i day, when it amounted to 3770 grains in twenty-four hours
(which is at least three times more than the average during health — Lehmann,
1. c. page 217. Zimmermann considers this increase of the uric acid and its
salts, at the period of the critical change, as important for the doctrine of cri-
sis, as he had opportunity to observe the same phenomenon, not only in pneu-
monia, but likewise in typhoid fever, ague, measles, etc. From three examina-
tions of the blood obtained during the first seven days in this case, and from his
previous experience, Zimmermann considers as the most important changes
in the inflammatory blood — that it is less coagulable than the blood in health;
that the quantity of fibrine is augmented ; that the colored blood globules are
diminished in number, and possess an abnormal disposition for the formation
of rolls ; that the colorless globules are found in an increased proportion, and
show likewise a tendency to join in groups. (Ibid.)

V. — Adulteration of Sulphate of Quinine.
by dr. moll;

The excessive price of the true cinchona, the calisaya of Bolivia, has led to
the substitution of many inferior kinds, chiefly remarkable for their containing
large proportions of quinidine. In consequence of their lower price, they have
obtained an admission to the quinine manufactories in large quantities, and much

784

The New-Orleans Medical and Surgical Journal.

of the sulphate now produced is depreciated by the addition of quinidine. This
substance differs from the sulphate of quinine by its greater specific gravity and
less flocculent crystalization, and it is much more soluble than it in water and
alcohol. The addition of both cinchonine and quinidine may be detected by
means of ether; for while cinchonine is almost insoluble in this substance,
quinidine is so in a far less degree than is quinine, inasmuch as sixty drops of
ether and twenty of ammonia will dissolve ten grains of quinine and only one
grain of quinidine. On the addition of these quantities of sulphuric ether and
liquor ammonia to ten grains of quinine, with ten drops of dilute sulphuric
acid and fifteen of water, all will remain dissolved, unless cinchonine, or more
than ten percent of quinidine be present in the /ethereal solution, it will soon
crystallize on the surface. If ten per cent of quinidine be present in the ethe-
real solution, it will soon crystallize on the surface of the ether. Traces of
this substance can be yet more certainly discovered, if ether saturated with
quinidine be employed, when all that exists in the suspected salt will remain
insoluble. If the powder contain cinchonine, or more than ten per cent quini-
dine^ it will remain undissolved at the line of demarcation of the two fluids.
If itbe quinidine, it is soluble in additional ether, which cinchona is not.

To establish the purity of quinine, we must also assure ourselves of the ab-
sence of inorganic substances, by calcination in platina, or by a solution of the
salt in alcohol. Sulphate and carbonate of lime, magnesia, etc., remain un-
dissolved, while boracic acid, though soluble, betrays itself by its blue flame
on conflagration. The absence of organic substances, as salicine, sugar,starch,
stearic acid, is known by the colorless solution which takes place in concentra-
ted sulphuric acid. The presence of ammoniacal salts is revealed by the odor
which ensues on the addition of caustic alkali.

(Revue Med. Chirurg.)

VI. — Temporary Albuminuria.

BY DR. BEGBIE.

Doctor J. W. Begbie alludes to the phenomena of albuminuria in the follow-
ing diseases :

1. Scarlatina Simplex. He confirms a former statement, that about the pe-
riod of desquamation, albumen can almost always be found ; its presence is
associated with renal epithelium, but not with the casts of tubes.

3. Erysipelas. Usually at resolution, or during convalescence. Its pre-
sence is not constant, nor its quantity great.

The albuminuria in these three cases is called desquamative.

4. Scarlatinal Dropsy. The albuminuria may or may not be temporary-
blood exudation-corpuscles, and casts of tubes, accompany it.

The albuminuria in this case is termed inflammatory.

5. Pneumonia, at the period of resolution, in almost all cases.

6. Typhus and Typhus Abdominalis (typhoid). From a consideration of the
period when the albumen is observed in these last named diseases, Dr. Begbie
terms it critical albuminuria.

(Monthly Journal of Medicine.)

•

Excerpta.

785

VII.— -Child Poisoned by an over-dose of Laudanum — restored by Galvanism.
The March number (1853) of the London Lancet contains the report by Dr.
Kirk, of a case of poisoning by laudanum, in which galvanism was successfully
applied after all other means had failed. When the child, only one month
old, was first seen, it had no pulse, hands and feet cold, features shrunk
and deadly pale ; aroused with difficulty , and soon relapsing into a state of com-
plete stupor ; pupils contracted ; respiration slow and scarcely perceptible ;
suspended at intervals.

The child being unable to swallow, Mr. Kirk applied one of the conductors
of a galvanic battery over the epigastrium, and taking the other conductor in
his right hand, he passed one of the fingers of his left hand into the mouth
of the child, between the teeth and gums, as far back towards the fauces as it
could be conveniently carried (the battery acting as feebly as possible). In
the meantime the breathing became regular, the action of the heart wag
steady and more vigorous, and all the symptoms of approaching death disap-
peared. As often as the galvanic influence was withdrawn, all the unfavorable
symptoms returned; buttbey again disappeared, on the renewal of the agent.
At the end of about four hours, Mr. K. succeeded completely in restoring the
child, when a mild emetic was administered, followed by a dose of oil, and the
child rescued from its perilous condition.

[Condensed — Ed. N. O. Jour.]

VIIL — Chlorate of Potash in Croup.

The following facts, as given by Dr. Sankey, corroborate the views laid down
by Dr. Budd in his paper on Croup : A child aged 13 months, with Croup and
Bronchitis, was treated with blisters, salines, ipecac, etc., without benefit^
when he was put upon the use of chloiate of potash; and although the child
was much reduced, the circulation languid, the blood not properly oxygenized,
yet in a a short time the Croup and Bronchitis disappeared, and the child was
restored to its usual good health.

Another child, ast. three years, with Croup, had been treated with leeches,
calomel and ipecac, without much benefit ; he was put upon the chlorate of pot.
ash, and soon his breathing became easy, and his countenance lost its anxious
and livid hue. It recovered as in the first case. The chlorate of potash is
supposed to be in part decomposed, in these cases, and thus a large portion of
its oxygen is given to the blood, for the absence of which the child perishes
in attacks of Croup*

(Condensed from Braithipait's Retrospect.)

786

The New -Orleans Medical and Surgical Journal.

IX.— A Remedy for Indigestion.

Doctor Spurgin, who has had much experience in the treatment of gastric
affections, recommends the following as a speedy and efficacious remedy for
indigestion :

Liq. Potassae

Sodii Chloridi, a a 3 i

Sodas Phosphatis 3 iss

Aqua Purae, j§ iii M

Of the above fluid we may take one third, either in soups or other nutricious
fluids, at our meals. In England, many families have it on their tables for
daily consumption ; and even make their tea by first putting two or three tea
spoonsfuls into the tea-pot with the tea. Used in this manner, it promotes di-
gestion and obviates the ill effects arising from this distressing complaint.

(Ibid.)

X. — A new Styptic to arrest Hemorrhage.
A number of well authenticated cases of hemorrhage, in which the following
styptic has proved completely successful have been reported in the French
journals by C. Sedillozt. A single drop will immediately coagulate a cupping-
glass full of blood ; and a large quantity of it will convert blood into a firm and
resisting solid. When applied to a bleeding wound, the hemorrhage is ar-
rested almost in an instant, by the creation of a solid clot on the orifices of the
bleeding vessels. This styptic may be thus prepared : Take eight ounces of
balsam of benzoin, one pound of sulphate of alumina and potassa, and ten pounds
of common water, and boil these for six hours in a glazed earthen vessel, care
being taken to add fresh quantities of boiling water to supply the loss in evapo-
ration, and stir constantly. At this time the super-natant liquid is separated
from the undissolved benzoin; then filtered and preserved in glass bottles. It
is now fit for use. Thus obtained, the liquid is limpid, and resembles in color
champaigne ; its taste is styptic, and odor pleasant and aromatic. It may be
applied by soaking a piece of lint in the fluid and binding it over the bleeding
surface.

(Abridged from Ranking. — Ed. N. O. Jour.)

XL Iron associated with Manganese in Diseases of the Blood.

Repeated experiments by Petrequin and others prove, that the restorative
properties of iron in chlorotic and anaemic conditions of the system, may be
greatly enhanced by combining manganese with this article. It is especially,
says M. Petrequin, in diseases of the blood, that ferro-manganic compounds are

Excerpta.

787

useful ; these combinations act specially on the vascular apparatus — on the
formation of the blood, and on the circulating fluid itself. They do not act
merely as tonics or as astringents ; but they regenerate the blood. Hence
the value of this compound in the anaemia following hemorrhage, surgical
operations, etc. In the chlorosis attending the age of puberty in females, and
the critical period of life, iron, combined with manganese, acts most benefici-
ally, as experience has demonstrated.

In functional affections of the heart, attended with chlorosis and other anaemic
conditions of the general system, iron and manganese have been found emi-
nently efficacious. The disordered state of the nervous system, usually at-
tendant on lesions of the circulating fluid, may be radically relieved by the pre-
paration under consideration.

M. Petrequin gives several formulas for the preparation of these two articles
some of which we shall notice for the readers of the New Orleans Medical and
Surgical Journal.

Pills of Carbonate of Iron and Manganese. Take of pure crystalized sul-
phate of iron 75 parts; pure crystallized sulphate of manganese 25 parts;
crystallized carbonate of soda 120 parts ; honey 60 parts ; and water, a suffi-
cient quantity. Mix and make pills ; let each contain about three grains ; of
these from two to four may be given daily.

Syrup of Lactate of Iron and Manganese. Take of lactate of iron and
manganese, 4 parts ; powdered sugar lb' parts ; rub together, and add distilled
water 200 parts ; dissolve rapidly, and pour into a mattrass over a water bath,
containing 384 parts of broken sugar ; then filter the solution. Of this syrup,
one or two spoonfuls may be taken daily.

As the commercial salts of manganese contain more or less copper, and even
arsenic, it has been recommended to calcine the sulphate of manganese two or
three times and with great care, to free it from these deleterious metals, before
it can be introduced into the system. (Ibid. — Ed.N. O. Jour.)

XII. — Bronchocele cured by Ligature of Superior and Inferior Thyroid

Arteries.

M. Porta, at the General Hospital of Paris, in July, 1850, ligated both the
superior and inferior thyroid arteries, for a "circumscribed and rapidly grow-
ing goitre of the left side" of the neck, in a young girl between 17 and 18 years
of age. The cure was effected, notwithstanding retarding circumstances, by
the end of October ; when there remained neither tuberosity nor rigidity, and
the neck had recovered its natural dimensions. (Ibid.)

788 The New-Orleans Medical and Surgical Journal.

Xin. — Collodion in Orchitis.
M. Dechange has succeeded in dissipating, in a very short time, testitis, by
smearing a thick coating of collodion over the scrotum. It acts by compres-
sion and excluding atmospheric air — the latter, according to M. M., being a
powerfully exciting cause of inflammation. (Ibid.)

XIV. — A new mode of Cauterizing the Larynx.
We learn from the Lancet, that Dr. Cotton has suggested to the London Me-
dical Society, a new method of applying a solution of nitrate of silver, or any
other substance to the laryngeal mucous membrane. From experiments at
the Consumption Hospital, Dr. C. was led to adopt a new mode of introducing
caustic solutions into the larynx. The little instrument with which this was
accomplished, consisted of a pair of forceps, slightly curved, and having a
small piece of sponge attached to one of its blades. By depressing and slightly
drawing upward the tongue with a spatula, the extremities of the blades could
be held over the larynx, and at the proper moment, the contents of the sponge
charged with the caustic solution, should be squeezed into the larynx. Doctor
Cotton says he has used it in a number of cases with the happiest effects, and
with but slight inconvenience to the patient. Half a drachm of the fluid was
sufficient for one sitting.

XV.— On Laryngisimus and Epilepsia Laryngea and Tracheotomy.

BY MARSHAL HALL, M. D.

Dr. Hall, after discussing at great length the benefits of this operation for
the relief of laryngisimus, says :

I trust it will not again be asserted that tracheotomy has been proposed as a
cure for epilepsy. Tracheotomy is, in fact, a cure for no disease. In laryngi-
tis, in which it is used, it averts the immediate danger to life, and affords time
and opportunity for remedies. In epilepsy, in which it never before was used,
it does more ; it averts the immediate and the remote dangers to life, and in-
tellect and limb ; it renders the attack abortive, reducing it from the graver to
a milder form, affording time and opportunity for remedies, and for the gradual
subsidence of augmented excitability of the nervous centre, and of the suscepti-
bility to attacks, excited and left by the disease in its unmitigated form.

[Lancet.]

XVI.— Morphia and Chloroform in Puerperal Convulsions.

BY ANDREW BOLTON, ESQ.

Elizabeth — , aged twenty-two, unmarried, at the full period of a first

pregnancy, healthy, but for some time past in a desponding way, was seized on
the 9th of Januarv, at 4 o'clock, A. M., with pain in the head and loss of vision.
At 8 A. M. I was summoned in time to witness a severe convulsive paroxysm.

Excerpta*

789

attended with stertor, lividity of countenance, and apparent impending suffoca-
tion. Twenty ounces of biood were drawn from the arms, and the cold douche
unsparingly used to head and shoulders. In ten minutes she was calm again,
the pulse reduced in tone, 100. On examining the os uteri, it was felt high,
slightly dilated, and extremely rigid. The mere introduction of digit sufficed
to brijig on the convulsions, which recurred again and again, with intervals of
five or ten minutes, the whole muscular system participating in the spasms.
Eleven, A. M. Paroxysms continue, and she is with much difficulty restrained.
At the suggestion of my father, two drachms of Sol. Morph. Ph. L. were given,
producing an hour's repose* Half past twelve. Dose of morphia repeated,
convulsions having recurred with increased violence. Countenance and gene-
ral surface pale ; the extremities cold. As her condition appeared hopeless,
should the paroxysms continue, chloroform was administered, on a piece of
linen, in half drachm doses, and its full effect kept up for three hours. At two
P. M. there was a slight return of convulsion ; skin warm and perspiring; the
os uteri was found steadily dilating ; and from her uneasy movements, it was
apparent that the uterine action had begun. Half past three. The membranes
were ruptured, and brisk uterine action ensuing, a dead child was expelled,
immediately followed by placenta. She gained her senses during the expul-
sive efforts, but appeared entirely ignorant of her previous condition. Recov-
ery followed without any bad symptoms.

In conclusion, I would remark, that the convulsions were in no measure
mitigated by the depletion, which was carried to the utmost, nor was there any
yielding of the os uteri until the chloroform was inhaled.

{London Lancet.)

XVII.— On certain important ■points in the Chemistry and Pathology of the

Urine.

BY DR. HASSALL.

Dr. Hassall publishes a paper in the March number of the London Lancet
on the principal tests employed in the detection of sugar in the urine. After
referring to preceding articles, in which he gave the results of certain obser-
vations and experiments, on the action of the potash and copper tests for sugar
in the urine, he continues :

I showed, contrary to what had been previously stated, that potash, when
boiled with non-saccharine urine, almost always deepened the color, and hence
I inferred that this test cannot be relied upon for the dejection of small quanti-
ties of sugar in the urine.

I showed,, likewise, that diabetic sugar, in quantities by no means inconsid-
erable, might be introduced into many urines, and yet not afterwards be de-
tected by the most careful application of the copper test ; further, I began the
attempt, to trace out, to what causes this very frequent failure was to be
attributed.

With this view, I proposed to experiment with all the principal salts and
substances proper to the urine, in order to ascertain which of them affected
most the action of the test.

I showed that urea, in the quantities in which it is ordinarily present, did not
affect the test, but that carbonate of ammonia, the principal part of which, con-
tained in the urine, is derived from the transformation of the urea, exerted an
influence over its action by no means inconsiderable, although not in itself suffi-

102

790 The New-Orleans Medical and Surgical Journal,

cient to explain the decisive failure of the test. I therefore first endeavored to
determine the conditions which occasioned the transformation of the urea, with
the object of ascertaining whether, during the application of the copper test,
carbonate of ammonia was really evolved or not, and I found, as the results of
numerous experiments —

1st. That the simple act of boiling an aqueous solution of urea is sufficient
to determine the gradual dissolution of that substance, and its conversion into
carbonate of ammonia ; a result at variance with statements made on this sub-
ject, particularly with one advanced by Dr. Bence Jones, and which was ad-
verted to in a former article.

2d. That this conversion of urea takes place, after a time, in distilled water,
even without the aid of the spirit-lamp.

3d. That the decomposition of urea is effected, either with or without heat,
much more rapidly in fluids which are alkaline, and especially in those, the
alkalinity of which arises from the presence of lime in any form.

4th. That the conversion of urea is retarded, and sometimes altogether pre-
vented by an acid condition of the the fluid in which it is present, and this is
equally the case whether the solution be subjected to the heat of the spirit-
lamp or not ; the more acid the fluid, the greater its power of resisting the
decomposition of the urea.

5th. The animal matter in a state of decomposition exercises a powerful
influence over the transformation of urea ; and this it does by producing an
alkaline condition of the fluid in which the urea is contained, the alkalinity
being produced by the carbonate of ammonia generated during putrefaction.

From all this, it appears therefore that carbonate of ammonia is, in some in-
stances, evolved from the urine during the application of Trommer's test ; but
scarcely, however, to such extent as to occasion of itself the failure of the test,
although it no doubt contributes in some degree to that failure.

I next experimented with the remaining salts, either constantly or occasion-
ally present in the urine, and ascertained, as far as possible, which of these
most affected the success of the test.

With one fourth of a grain of urate of ammonia dissolved in half a drachm
of distilled water, holding one eighth of a grain of sugar in solution, the test
failed; with the eighth of a grain of sugar it succeeded imperfectly only ; but
with the sixteenth it was successful.

The carbonates of lime and magnesia are but seldom, if ever, found in hu-
man urine, except as the consequence of decomposition; it was therefore hardly
necessary to experiment with these. I may state, however, that on the addi-
tion of two drops of a saturated solution of a sulphate of copper to one half
drachm of a solution containing carbonate of lime dissolved by excess of car-
bonic acid, and the thirty-second of a grain of diabetic sugar, the test was found
to answer satisfactorily.

With one grain of phosphate of lime to half a drachm of a solution slightly
acidified with dilute phosphoric acid, containing one eighth of a grain of sugar,
no precipitate formed on the application of the test ; with half a grain of the
phosphate, a brownish modification of the black oxide appeared ; with a quar-
ter of a grain, the precipitate was of a lighter brown ; with one eighth, it was
of a reddish brown ; with one sixteenth, of a very light brown ; and it was
only with the thirty-second of a grain of phosphate of lime that the precipi-
tate became of a dirty and dull yellow, sufficiently characteristic, however, of
the presence of sugar.

In similar quantities of saccharine solutions, of the same strength as in the
previous case, containing respectively the eighth, sixteenth, thirty-second and
sixty-fourth of a grain of phosphate of magnesia, no precipitate appeared ;
and with the one hundreth and twenty-eighth of a grain, a cherry red or brown-
ish precipitate was thrown down.

With one grain of phosphate of ammonia the precipitate was of a decided

Excerpta*

791

brown ; with half a grain, of a light brown ; with one fourth, of a yellowish
brown ; and with one eighth, the test was successful.

W th one grain of the phosphate of soda, the precipitate was brown ; with
half a grain, the same; with one fourth, it was of a brick red color; with
one eighth, of a light red; and with the one sixteenth, the test was suc-
cessful.

The conclusions to be deduced from these experiments will be considered
hereafter.

The results of the experiments made with the sulphates were as fol-
lows

In a solution containing two grains of sulphate of potash and one sixteenth
of a grain of sugar, the precipitate was dark yellow, and characteristic of the
presence of the sugar.

With one grain of sulphate of magnesia and the thirty-second of a grain
of sugar, the precipitate was a red or lake color, and the same with twice
the quantity of sugar ; with one eighth of a grain of sugar, the test suc-
ceeded

In experiments made with the oxalates, the following results were ob-
tained : —

In a solution containing the one hundred and twenty-eighth of a grain of
oxalate of ammonia, the test succeeded imperfectly only.

With one grain of binoxalate of potash, the precipitate was gray, with half a
grain pinkish, and with one fourth, bright yellow.

In a solution with one grain of oxalate of lime dissolved in dilute hydrochlo-
ric acid, the red oxide was copiously precipitated.

The chlorides gave the following results :

In a solution containing two grains of chloride of sodium, the test was per-
fectly successful. It was equally so in a solution of chloride of calcium of the
same strength.

The results with the acids were as follows :

The test answered very well in solutions containing one and two grains of
tartaric acid to the half drachm of fluid, and the sixteenth and thirty-second of
a grain of sugar.

With one grain of citric acid, and one sixteenth of a grain of sugar, the
test succeeded fully well ; but it failed when the acid was increased to two
grains.

With one grain of oxalic acid, and the one sixteenth of sugar, a rich golden
yellow precipitate subsided; but with the thirty-second of a grain of sugar the
precipitate inclined to green, and could not be distinguished with certainty as
a modification of the red oxide.

With five drops of dilute phosphoric acid, the test was likewise completely
successful.

Animal matter, mucus, epithelium, and particularly albumen, have been said
to interfere greatly with Trommer's test. It succeeded, however, completely,
in the ordinary saccharine solution, to which half a drop of white of egg was
added.

The quantity of liquor potassa employed in the above experiments, except in
the case of the acids, in which half a drachm was used with each trial, was not
measured, but was added in the ordinary manner. It would have been better
to have employed in qach case a definite quantity ; the results, however, are
sufficiently accurate to serve the purpose for which the experiments were
instituted.

We have now to consider whether it appears, from the foregoing experiments,
that any of the other constituents of the urine, in addition to the carbonate of
ammonia, are ever present in quantity sufficient to occasion the failure of Trom-
mer's test.

792

The New-Orleans Medical and Surgical Journal,

The chlorides, sulphates, the acids and albumen, do not require to be further
noticed, as they do not appear to affect the test in any sensible degree ; there
remains then for consideration only the urate of ammonia, the phosphates, and
the oxalates.

Urate of ammonia, which is often present in the urine in such large quantity,
exerts a very marked effect over the action of the test, which is successful
only in solutions which do not contain more than one grain of the urate to the
ounce of fluid holding dissolved two grains of sugar.

The phosphates, as appears from the experiments, affect to a considerable
extent the successful action of the test, but particularly the earthy phosphates ,
and especially the phosphate of magnesia. Thus the test will not succeed in
solutions containing two grains of sugar and more than two grains of phos-
phate of ammonia, one grain of phosphate of soda, half a grain of phosphate
of lime, and the one eighth of a grain of the phosphate of magnesia, to the
ounce.

The oxalates, likewise, affect very greatly the copper test, especially the
oxalate of ammonia ; but the affinity of the oxalic acid is so great for lime,
which is always present in the urine, that oxalate of ammonia is contained in
that fluid probably only very rarely, and in ordinary cases, therefore, it has little
or nothing to do with the non-success of the test.

It is then evident, that several of the constituents of the urine, even when
separated from each other, do affect the success of the copper test ; and there
is no doubt but that in some cases, acting in combination, they are the cause
of its failure.

The same conclusion is proved in another way, viz., by the results of the eva-
poration of different urines.

Four grains of diabetic sugar were dissolved in two ounces of each of the
following urines, which, after being first tested for the sugar, were carefully
evaporated to the consistence of syrup ; a portion of the residue of each was
re-dissolved in distilled water, and again tested ; the results before and after
evaporation being shown in the following table :

First Urine. Trommer's test, before evaporation, failed ; after, acted very
imperfectly.

Second Urine. The test, before evaporation, failed ; after, succeeded imper-
fectly.

Third Urine. The test acted imperfectly before, and nearly the same after
evaporation.

Fourth Urine. The test failed both before and after evaporation.
Fifth Urine. The same results.

Sixth Urine. Failed before, but succeeded after evaporation.
Seventh Urine. Failed before, but succeeded after evaporation.
Eighth Urine. The test acted very slightly before, but very decidedly after
evaporation.

Ninth Urine. Acted very slightly before, but very decidedly after evapo-
ration.

Tenth Urine. Did not act at all before, but very decidedly after the evapo-
ration.

Now the increased, but not at all complete or invariable, success of the test
after evaporation, is explained by the partial precipitation of the earthy phos-
phates and the urate of ammonia, as well as, in some cases, where the urine
is not very recent, by the dissipation of the carbonate of ammonia.

But, as we see, the test still very frequently fails; and in what way are these
failures to be explained and overcome ? They are explained, I believe, suffi-
ciently, in many cases, by the solvent action of the distilled water, which is
capable of taking up enough of the constituents of the urine to defeat the
operation of the test.

On referring to my notes, I observed that in those cases in which the test

Excerpta.

793

was most successful, the urines were of low specific gravity, and were but
slightly acid or even alkaline; while, on the other hand, the urines in which it
failed were of high specific gravity, and usually strongly acid.

It therefore occurred to me, that the condition of the urine, as to acidity, was
at least one of the causes of the failure of the test. Acting on this idea, I
rendered the urine alkaline previous to the addition of the copper, and subse-
quently added the alkali in very large excess. Since I have adopted this plan,
I have but seldom failed to detect a very small quantity of sugar, even when
purposely introduced into the urine.

In testing urine therefore for sugar, if acid, as it almost invariably is, when
that substance is present, it should be first rendered alkaline, and after the ad-
dition of the copper, a large excess of potash should be employed. The quan-
tity of sulphate of copper to be used, is in general about two drops of a satura-
ted solution ; but when it is suspected that the amount of sugar present is very
small, a much less quantity even must be employed.

When the liquid to be tested is not very acid, does not hold many salts in
solution, and when the sugar present is very small in amount — some minute
fraction of a grain — a very small quantity of potash and copper, especially the
latter, will be required.

The copper test may be employed ino ther ways than by boiling the urine
in a test-tube, over the flame of a spirit-lamp, after the addition of the re-
agents.

Thus, the urine and potash may be boiled together, and while on the boil,
the solution of sulphate of copper may be dropped in, when, if sugar be pre-
sent, the red oxide will be immediately formed.

Or, the copper and potash having been added to the cold iron in a test-tube,
this may be set aside for twelve or twenty-four hours, when the reduction,
should it contain sugar, will take place without heat. This I consider to be the
very best and simplest method of employing the copper test.

Failing in the first attempts to discover sugar in any urine by means of the
copper test, other trials should be made, using the re-agents in different propor-
tions, and in more than one of the ways pointed out.

Observing the precautions indicated, the operator will but seldom fail to dis-
cover sugar in urine, when present in even minute quantities, although in some
rare instances he will still do so. In such cases another test must be had re-
course to — the torulae test. (Lancet for March, 1853.)

XVIII. — Tracheotomy, and Extraction of a portion of Broken Glass.

BY MR. J. GRAHAM.

On the 8th October, 1852, Thomas G. G— — , aged eight, was brought has-
tily to the infirmary in a suffocating state, in consequence of a portion of bro-
ken glass having got into the windpipe. Sir J. Fife was soon brought, and on
applying a stethoscope to the front of the throat, pointed out to the pupils around
a distinct whistling sound, most evident below the cricoid cartilage. The boy
was put under the influence of chloroform. A transverse fold of integument
being taken up and cut through, the veins and muscles were exposed and drawn
aside, the mesial line was cut open, and the windpipe penetrated close below
the cricoid cartilage. A probe-pointed bistoury was then introduced, by which
Sir J. Fife divided downwards to about an inch of the trachea ; this was fol-
lowed by the expulsion of a piece of glass, in a convulsive paroxysm of
coughing.

9th. Pulse quiet ; breathing easy.

10th. Wound healing ; voice restored.

12 th. Convalescent. (Ibid.)

794

The New-Orleans Medical and Surgical Journal.

XIX. — The Chemist's Dream.

The following ingenious and singular effusion has been placed in our hands
by a chemical friend. We do not vouch that it has never been published be-
fore, but it will repay perusal during an idle moment. We are informed that
it was actually written by a medical student some years ago in Philadelphia,
but of the exact time of writing, or of the name of the author, the deponent
saith not. (Stethoscope.)

Methought I was exploring the hidden recesses of an extensive cave, whose
winding passages had never before echoed to the tread of human foot. With
admiration and delight I was gazing at the thousand wonders which the flash-
ing torchlight revealed on every side,at each step of my progress,when a strange
sound, as of the hum of many voices, fell upon my ear. What such a sound
could mean, in such a place, was more than I could divine. Curiosity led me
in the direction whence it came. The buzz of the conversation, cheerful, as
it would seem, from the occasional bursts of merriment that were heard, grew
more and more distinct, until the dark and narrow passage I had been follow-
ing suddenly opened upon one of those magnificent rock parlors, of whose
grandeur and beauty description can convey but a faint idea. A flood of light
illuminated the arching roof, with the vast columns of stalactites sparkling
with crystals that supported it, and was reflected with imposing effect from the
huge streets of the same material, of the purest white, that hung from the
ceiling in graceful but substantial drapery. I stood in one of nature's noblest
halls, but not alone.

A strange company had gathered there. Black spirits and white, blue spir-
its and gray, were before me. A festive occasion had assembled, in joyous
mood and holiday attire, the firstborn of creation — the Elements of things.

In dreams, nothing ever surprises us. It seemed perfectly natural to see
these fairy forms in that grotto. So, accosting without hesitation the one near-
est to me, I apologised for my intrusion, and was about to withdraw. From
my new acquaintance, however, I received so cordial a welcome and so earnest
an invitation to become a participator in their festivities, that I could not deny
myself the pleasure of accepting the hospitality so kindly offered.

I was soon informed that some of the leading characters among the elements
had resolved, some weeks previous, upon having a general pic-nic dinner party.
Sixty-three family invitations had accordingly been sent out, one to each of
the brotherhood, and preparations for the feast made upon a most extensive
scale. Sea and land had been ransacked for delicacies, and everything was
put in requisition that could contribute to the splendor of the entertainment or
the enjoyment of the occasion.

At the hour I so unexpectedly came upon them, nearly all the guests, with
their families, had assembled in the strange drawingroom 1 have described,wait-
ing the summons to the banquet.

Spacious as the drawing room was, it was nearly filled with these interest-
ing children of nature. And here they were seen, not as in the chemist's labo-
ratory, writhing in the heated crucible, or pent up in glassy prisons, or peering
out of gas-holders and Florence flasks, but arrayed in their beauty, each free as
air, and acting as impulse prompted. There were those present of every hue,
every style of dress, every variety of appearance. The metals, the gases, the
salts, the acids, the oxides and the alkalies, all were there.

From the mine, from the shop of the artizan, from the mint, from the depths
of ocean even, they had come, and a gayer assemblage, a more animating scene
my eyes had never beheld. Many of the ladies of the party were most taste-
fully attired.

Chlorine wore a beautiful greenish yellow robe, that displayed her queen-like
figure to good advantage.

Excerpta.

795

The fair daughters of Chromium particularly attracted my attention, with
their gay dresses of the loveliest golden yellow and orange red.

Iodine had just arrived, and was not yet disencumbered of an unpretending
outer garment of steel gray that enveloped her person:; but the warmth of the
apartment soon compelled her to lay this aside, when she appeared arrayed in
a vesture of thin gauze of the most splendid violet color imaginable.

Carbonic Acid was there, but not clad in the airy robes in which I expected
to see her. The pressure of the iron hand of adversity had been upon her, and
now her attire was plain, simply a dress of snowy white, the best which the
straitened circumstances to which one was reduced allowed her to assume.
Quite a contrast to her was her mother.

Carbon, whom you would have supposed to have been a widow in deep mourn-
ing, or a nun who had taken the black veil — so sable were her garments, so
gloomy her countenance — had not her earrings of polished jet and a circlet of
diamonds that glistened on her brow evinced that she had not altogether renoun-
ced the world and its vanities.

The belle of the room appeared to be Nitrous Acid, the graceful daughter of
Nitrogen, airy in all her movements, and with dress of deepest crimson, that
corresponded well with a lip and cheek rivalling the ruby in redness. Among
the lady metals, too, there were many bright faces and resplendent charms ;
but I must pass on to a description of the gentlemen of the party.

Sulphur wore a suit of modest yellow plush, while Phosphorus quite discon-
certed some of the most decorous matrons present, by making his appearance
in a pair of flesh-colored tights.

Phosphuretted Hydrogen, or as he is nicknamed " Will-of-the-Wisp," startled
me, by flitting by in a robe of living flame, the dress in which the graceless
youngster is said to haunt church-yards and marshy places, playing his pranks
upon poor benighted travellers.

Gold, the king of metals, was arrayed in truly gorgeous apparel, though it
must be confessed there was a glitter and an air of hautiness about him, from
which you would turn with pleasure to the mild sweet face of his royal sister,
{Silver, who leaned upon his arm, a bright-eyed unassuming creature of sterling
worth.

Mercury was there, as lively and as versatile as ever, a most restless being,
now by the thermometer, noting the subterranean temperature, now by the
barometer, predicting a storm in the regions overhead, now arm-in-arm with
this metal, then with that, and they all, by the way, save stern old Iron, had
hard work to shake him off. A strange character surely was he — a philoso-
pher of uncommon powers of reflection ; the veriest busy-body in the world,
well versed in the healing art; a practical amalgamist ; in short, a complete
factotum.

Potassium, though a decidedly brilliant looking fellow, manifested too much
levity in his deportment to win respect, and was pronounced by those who
knew him best, to be rather soft.

Platinum, in gravity, surpassed all the rest, and in natural brightness was
outshone by few.

When Oxygen arrived, and his light, elastic tread was heard, and his clear
transparent countenance was seen among them, a murmur of congratulation
ran around the drawing-room, and involuntarily all assembled rose to meet him
and do him homage. He was a patriarch indeed among them ; literally a father
to many of the youngest guests. His arrival was a signal of adjournment to
the banquetting room, where of right he took his position at the head of the
table. .

Concerning the apartment we had now entered, I can only say it was grand
beyond description. It was lighted up with the brilliancy of noon-day, by an
arch of flame intensely dazzling, produced by a curious apparatus which Gal-
vanism, who excels in these matters, had contrived for the occasion out of

796 The New- Orleans Medical and Surgical Journal.

some materials which his friends Zinc and Copper had furnished him. Fes-
toons of evergreens and wreaths of roses encircied the alabaster columns, and
made the whole look like a hall in fairy land. But I must describe the table
and its paraphernalia — the preparation of viands — I mean the baking, boiling',
roasting, stewing, and the like, which had been committed to Caloric, who had
long experience in that department.

The nobler of the metals had generously lent their costly services of plate,
while Carbon united with Iron to furnish the elegant steel cutlery used on the
occasion.

Alumina provided the fine set of china that graced the table, and Silex and
Potash, without solicitation, sent as their joint contribution, cut glass pitchers
and tumblers of superior pattern and transparency. As among the sons of na-
ture there is no craving for artificial excitement, Oxygen and Hydrogen — who,
by the way, have done more for the cold water societies than Delavan and
Father Mathew — were commissioned to provide the drinkables, and what bev-
erage they furnished may be easily conjectured.

Carbon, with Oxygen and Hydrogen, found most of the vegetables, and Ni-
trogen, whose assistance as commissary here was indispensable, joined them
in procuring the meats under which the table groaned. No taste but would be
satisfied with variety, no appetite but would be cloyed with the profusion of
good things. Though the liberality of the four that have been mentioned left
but little lor their associates to contribute, still some individual offerings to the
feast deserve to be mentioned.

Thus, the oysters, Carbonate of Lime had sent in shell; the pyramids of
ice cream for the dessert were provided by the daughter of Chlorine and Hydro-
gen, the bride of Sodium, who was out several hours in the snow, engaged in
freezing them ; and the almonds and peaches came from the conservatory of
Hydrocianic Acid, the druggist.

After grace had been said by Affinity, who is a sort of chaplain to the Ele-
ments, having officiated at the weddings of all the married ones of the com-
pany, a vigorous onset was made upon all the good things before them. At
first all were too much engaged for conversation ; but the dessert appearing
at last, as they cracked their nuts, the jests too were cracked. Song and toast
were called for, and wit and innocent hilarity became the order of the day.
Even Oxygen, who had presided with such an air of dignity, relaxed from
his sternness, and entertained the younger ones at the table with many a
tale of his mischievous pranks in the days of old father Chaos, when Time
and himself were young. Strange tales they were too, of earthquakes with
which Hydrogen and he would now and then frighten the Ichthyosauri and
Megatheria of the ancient world, and of conflagrations comical, as of old Vul-
can's tongs and anvil, kindling them before his eyes with the very bolt he was
forging. This, however, he added, with a sly glance at his old partner, Ni-
trogen, who sat near, was before marriage had sobered down his spirits and
tamed his impetuosity.

I have no space to chronicle more of the freaks of Oxygen's early youth, nor
any of the sayings and doings of others of this memorable night's party, else
I might, relate the marvellous story Nickel had to tell about the manner in
which he managed to deceive and wrong the miners of former days, by making
them believe that he was the parent of Copper, until at length they concluded
that he was an evil spirit, whose sole object was to interrupt their operations.
I would tell, too, of the drolleries of Nitrous Oxide, that funniest, queerest,
craziest of youngsters, and how Phosphorus made a flaming speech, and Pot-
ash a caustic one, and how Mercury proposed as a toast, " the medical profes-
sion to whom we say, use us, but don't abuse us." I must speak, however,

of a curious by-scene I chanced to witness. It was a flirtation that Platinum
was carrying on with Hydrogen, whom, much to my surprise, I found seated
up among the metals, and quite at home among them too. There was quite a

Excerpta*

79?

contrast between Platinum, gray, heavy and dull as he was, and the light and
buoyant creature by his side, but there soon seemed to be evidence of mutual
attraction between them.

So passed the evening ; all went on " merry as a marriage bell," with no-
thing to mar the good humor that prevailed, until, in an evil hour, Sulphuretted
Hydrogen, a disagreeable fellow, against whose appearance at the banquet
most of the company had protested, entered the apartment with a very offensive
air. In an instant the whole family of metals, to whom he is particularly ob-
noxious, changed color. Lead fairly grew black in the face with indignation ;
Arsenic and Antimony seemed to be jaundiced with rage; Ammonia, to whom
his presence recalled very unpleasant associations, in trying to avoid him,
precipitated several metallic oxides on the floor, while Chlorine, with more
self-command than the rest, advanced with a firm step to expel the intruder,
looking as if she were about to annihilate him on the spot. Well, at this crisis
he spied Nitric Acid ; and knowing that his destruction was certain if they
should come in contact, he at once withdrew, very much to the satisfaction of
the whole company.

How the scene might have terminated I know not ; for just at that moment
a strange sound of awful import, like the trampling of a mighty host, came to
my ears. I felt sure it was an earthquake's voice, and that now my fate was
sealed. My knees tottered under me — the arching grotto and festive board
gradually vanished from under my eyes, which opened upon the class as they
were leaving the laboratory of our worthy professor of chemistry — where,
it appeared, much to my confusion, I had fallen asleep during the lecture —
and

" Dreamed a dream in the midst of my slumbers."

S. R. H.

XX. — -Researches on the Pathology of Rheumatic and non-Rheumatic Peri'

carditis.

BY DR. ORMEROD.

Recently before the Royal Medical and Chirurgical Society of London, Dr.
Ormerod read a very interesting paper on these affections. He commenced by
a reference to the researches of the late Dr. Taylor, who had satisfactorily
shown that acute rheumatism was not exclusively the cause of pericarditis,
and who had also called attention to the importance of granular disease of the
kidney, in reference to this morbid condition. The author desired to limit the
use of the word pericarditis to present inflammation of the pericardium, and
this analysis referred exclusively to cases of this nature. The means of in-
vestigation comprehended complete records of 1410 cases, observed under
nearly similar circumstances ; that is, in the wards of different hospitals. Of
these 1249=88. 59 per cent were not cases of rheumatism; 161=11. 41 per
cent were admitted on account of rheumatism, or suffered from it while under
observation. Of the whole number 85=6 per cent had recent pericarditis,
observed during life, or discovered after death, and they were thus distri-
buted —

24=1.92 per cent occurred among 1249 non-rheumatic cases.
61=37.88 per cent. 161 rheumatic cases.

85=6 percent. 1410
The mean age of 61 subjects of rheumatic pericarditis was about 21 ; the

103

798 The New-Orleans Medical and Surgical Journal,

mean age of 24 subjects of non-rheumatic pericarditis was 42 ; the extremes
being 7 and 63 years. As to the different causes of the pericarditis :

Rheumatic— Cases coincided with acute rheumatism 61

Non-rheumatic of local origin- — Ensued on inflammation of lungs or pleura 7

Malignant disease of pericardium 2

Old cardiac disease 1
Non-rheumatic of constitutional origin— Coincided with granular disease

of the kidnies, • 6

Hemorrhage or exhaustion, 4

Scarlatina or erysipelas respectively 2

Inexplicable, 2

The date of the accession of pericarditis was determined in 33 of the rheu-
matic cases ; the mean of these observations gave the ]0.5th day of rheumatic
attack as that on which the pericardial complication most commonly supervened.
The question whether a first or second attack of rheumatism was more likely
to be accompanied by pericarditis, was beyond the reach of hospital statistics.
This source of information was silent also on the question, whether pericar-
ditis be more likely to occur in severe or in the slighter cases of rheumatic fever.
It might, however, be safely inferred, that the severity of the articular and pe-
ricardial affections bore no very close relationship to each other. It was cer-
tain that the most severe, even fatal pericarditis, might occur where there was
but faint evidence of articular affection, and this latter condition might exist in
the most aggravated and intense form, without involving the addition of peri-
carditis to the other sources of distress. The author then entered upon the
consideration of the subject of non-rheumatic pericarditis of local origin ; and
a question of importance here presented itself— What was the influence of pre-
existent cardiac or pulmonary affections in inducing inflammation of the peri-
cardium ? The question was of equal importance in relation to acute rheuma-
tism. The relation of pulmonary inflammation to pericarditis was thus illus-
trated : In the 1410 cases, the basis of this inquiry, some form of pulmonary
inflammation, that is, pneumonia, pleuritis, or pleuro-pneumonia, was ascer-
tained to exist, either by auscultation or dissection, in 265 cases. Of these—

117 had pneumonia, of which 19 had recent pericarditis.

86 had pleurisy, 6 "

62 had pleuro-pneumonia, 8 "

265 33=12.4 per cent

In the rheumatic class, pericardial inflammation commonly preceded, yet
sometimes, though rarely, followed, pulmonary inflammation. The non-rheu-
matic class told quite a different story ; here pulmonary inflammation had ap-
parently a distinct influence in inducing pericarditis, and this influence was
most evident in cases of pleurisy ; and clinical observation bore out the con-
clusion, that the pericarditis was subsequent to, and probably contingent on,
the pulmonary inflammation. The author then referred to the comparative fa-
tality of non-rheumatic compared with rheumatic pericarditis, and also to the
desirableness of instituting an exact comparison between Bright's disease of
the kidney and acute rheumatism, in respect to their tendencies to induce in-
flammation of the pericardium. In conclusion, the author desired to ascertain
how far the results obtained by his present analysis agreed with those of the
published cases of Dr. Taylor, who had made the subject of non-rheumatic pe-
ricarditis so peculiarly his own ; the deductions seemed identical, and one
arose from the perusal of those elaborate clinical reports with a conviction,
that non-rheumatic pericarditis was more within the province of the anatomist

Excerpta.

799

than of the physician. It was a disease with few or no symptoms, its physical
signs recognized more often by a chance discovery than on the suggestions of
the disease, and its morbid changes small in amount and apparently inactive;
and where opportunity had occurred of watching the disease some time previ-
ous to death, it had been apparently without effect on the general symptoms, its
presence or absence being determined by the ear alone; and still, in these, its
connection with the fatal termination had appeared to be that of a coincidence
rather than of a cause.

Dr. Copland felt obliged to the author for the very practical and literary way
in which he had brought his paper before the Fellows of the Society. The as-
sociation of disease, as exemplified in Dr. Ormerod's communication, showed
us that in practice, we must not look at cases of disease as always simple, but
frequently as complicated as these under discussion. All these were connected
with the morbid condition of the blood, and to this we must look as the cause
of the articular rheumatism, the pericarditis, the pleuritis, etc. All these were
evidences of the blood being in an abnormal condition, from whatever cause
it originated. Several organs became affected, and when an important disease
existed, it masked the minor one. We saw the same train of phenomena in
Bright's disease, in which inflammation of the serous membranes was liable
to occur from the non-elimination of morbid matter from the blood, and its con-
sequent circulation through the system. These combinations of disease should
be viewed in our routine of practice as the result of the morbid actiou in the
system. [Dublin Medical Press],

XXI. — Researches on Hematology.

BY BEQUEREL AND RODIER.

The following are the conclusions of a long series of observations upon
morbid changes in the blood, which have been recently communicated to the
Academie des Sciences, and reported in the Gazette Medicale de Paris.

1st. In the majority of chronic maladies, and in various other unhealthy
conditions, there is some increase or diminution in the normal proportions of the
three principal elements of the blood — the globules, the fibrine, and the albu-
men, and this in a single, double or triple order.

2d. The globules diminish in number in the course of most protracted chronic
disorders, and especially in organic affections of the heart, the chronic form of
Bright's disease, chlorosis, march-cachexy, hemorrhages of various kinds, ex-
cessive blood-lettings, the last stages of tubercular disease and the cancerous
diathesis; the globules disappear equally in those who are sunk in the depths
of poverty, and exposed to the conjoined evil of bad and insufficient food, and of
dark, damp, and ill-ventilated dwellings.

3d. The albumen of the serum of the blood diminishes, among other instances,
in Bright's disease, chlorosis, the march-cachexy, advanced heart disease, great
symptomatic anaemia, and in the state of ill health induced by poverty and
cancer.

4th. The proportion of fibrine is unaffected, or slightly augmented, in acute
scorbutis, but diminished in the chronic malady, especially in that symptomatic
form which often complicates permanent heart disease.

5th. In all the cases already mentioned the quantity of water contained in
the blood is considerably augmented.

6th. The more prominent signs of a diminution in the number of the glo-
bules are the following : Discoloration of the skin, palpitation, dyspnoea, bruit

800 The New-Orleans Medical and Surgical Journal.

de soufflet at the base of the heart during its first sound, an intermittent bruit
de soufflet in the carotids, and a continuous one in the jugulars.

7th. A rapid though slight diminution in the quantity of albumen, is marked
by acute dropsy. A more gradual diminution is followed by the same symp-
tom, but in this instance the loss must have been much more considerable than
in the former one. Dropsy, in fact, is the characteristic sign of a blood de-
prived of its natural amount of albumen.

8th. A diminution in the normal proportions of fibrine is followed by hem-
orrhage of one kind or another — mucous or cutaneous.

9th. In the anaemia which is symptomatic of copious hemorrhage, starva-
tion, or exhausting discharges, the blood is less dense and more watery than
natural, the globules are diminished in number, and the albumen and fibrine
unaffected, or the former slightly wanting.

10th. In chlorosis, which is an affection distinct from anaemia, the blood
may be unchanged. If it is changed, it has fewer globules and more water,
and a natural or somewhat augmented proportion of fibrine and albumen.

11th. In acute Bright's disease, the globules and fibrine remain unaltered,
and the albumen is wasted. In the chronic affections, the globules as well as
the albumen are deficient, and not unfrequently the fibrine also, though to a
less extent than the others.

12th. Most of the idiopathic dropsies are due to a want in the normal quan-
tity of the albumen of the blood.

13th. In fatal diseases of the heart, the blood progressively becomes more
and more impoverished in its three elements of fibrine, albumen and globules,
while at the same time it is much more watery.

14th. In acute scorbutis, the blood presents no appreciable alteration. In
the chronic affection, the blood is notably deficient in fibrine, while the globules
are, sometimes at least, considerably increased.

15th. These facts should exercise a great influence in practice, as we pos-
sess the means of acting upon the element which may be wanting or changed.
A tonic plan of treatment will be required when each of the three elements is
deficient, combined with quinine, steel, or acids, according as the deficiency
may be in the albumen, globules or fibrine ; one reason of the indication of
acids in the latter case being the presence of free soda in the blood when the
fibrine is deficient.

[Ranking^ Half Yearly Abstract.

Part ©l)triL

REVIEWS AND NOTICES OF NEW WORKS.

I. — A Discourse on the Life, Character and Services of Daniel Drake,
M. D. Delivered, by request, before the Faculty and Medical
Students of the University of Louisville, January 27th, 1853.
By S. D. Gross, M. D.
The Topical Uses of Water in Surgery ♦ By Charles A. Pope,
of St. Louis, Mo. Presented to the American Medical Associa-
tion, at its Session of May, 1852.
Lecture introductory to the Second Course in the Medical Depart-
ment of the University of Nashville. By W. K. Bowling,
M. D.

Report of the City Registrar of the Births, Marriages and Deaths

in the city of Boston, for the year 1852.
Report of the Pennsylvania Hospital for the Insane, for the year

1852. By Thomas S. Kirkbridge, M. D., Physician to the

Institution.

Report of the Obstetric Committee on Ancesthesia in Midwifery, and
the Speculum Uteri. By Henry Miller, M. D., of Louis-
ville, Ky.

Dr. Gross has, in a well written discourse, accorded full justice to
the character of the late Dr. Drake, as a Physician, a teacher of Medi-
cine, and an author, as well as in the social relations.

Commencing with his early life, the writer has faithfully collated
circumstances of interest, and placed them before the public in an
agreeable manner ; in an eventful life like Dr* Drake's, abundant mat-
ter was furnished the essayist for compilation, and Dr. Gross, in tracing

802 The New-Orleans Medical and Surgical Journal.

that life from youth to manhood, and from manhood to old age, has given
fresh evidence of the graceful style of his writing.

It is to be regretted that many of the works of Dr. t)rake are in too
unfinished a state for publication; and especially that in which his re-
search and ability were most conspicuous — his work on the Diseases
of the Interior valley of North America, as they appear in the varieties
of its population — the first volume only having been published in 1850 ;
the remaining part of this work (so far as completed) is promised to be
forthcoming under the direction of a competent editor.

The services rendered to his profession by Dr. Drake, are so well
known and fully appreciated, that further comment upon the discourse
is needless ; all due respect and honor have been paid to his memory
by Dr. Gross.

In his dissertation upon the Topical uses of Water in Surgery, which,
if we mistake not, was promised to the public some time ago, Dr. Pope
has considered its applicability as a curative agent at various tempera-
tures and in different states ; at the same time avoiding the error of
claiming it as a universal panacea, either in the local management of
external lesions, or, as a prophylactic against functional or organic de-
rangement.

The general employment of so simple an element as water, that
which all can obtain without money and without price, must win its
way to public favor and adoption, through vulgar prejudices, frequent
doubts and serious misgivings. The Physician who should venture to
tell his ignorant patient that nothing but pure water was required to
heal his unsightly ulcer,or to allay local inflammation, superficial though
it might be, need not be surprised if he have excited cupidity in the
mind of his hearer, as to the correctness and utility of his views ; nor
might the Physician receive any other consideration, from the class of
patients referred to, should he, relying upon the styptic effects of cold
water, by constringing the vessels and affording mechanical obstruction
to bleeding orifices, whether arterial (the smaller ones) venous, ^>r
capillary, attempt to restrain the flow of blood by the application of
that liquid, in the mode of affusion, irrigation, injection, douche, etc.,
although in a large proportion of cases, if assiduously and judiciously
applied, all further interference might cease.

Amongst the different opinions which have been entertained con-
cerning the therapeutic action of cold water, such as the reduction of
caloric, the effect on the nervous extremities, the absorption of the wa-

Reviews.-*- Addresses— Reports, etc, 803

ter, the diminution of the quantum of blood in the part, the uniformity
of its temperature maintaining a new action, etc., Prof. Pope is inclined
to think, with manifest propriety, that the diminution of the quantity of
blood, and the abstraction of caloric, act the most prominent and im-
portant part ; for, says he, cold applied to an inflamed part is, in one
sense, a kind of bandage. But over the bandage, cold possesses this
advantage, that while it compresses (constricts) it also largely depletes
the part by its abstraction of caloric. The two, by means of a wetted
roller, are often advantageously combined.

Certain experiments, made several years ago by my colleague, Prof.
M. L. Linton, satisfactorily show, that when a bandage is applied to
several, or all of the extremities at the same time, the pulse becomes
fuller and slower. Subsequent experiments made by Prof. Pope, have
been attended with like results.

Cold applications, observes Dr. Pope, are applied not only to the
cure of inflammation already established, but far oftener to prevent its
accession, when likely to follow previous injuries, and hence cold water
is recommended in wounds of various kinds, particularly in amputations
where union by the first intention is desired.

In reference to hernia, we employ the words of the writer. In in-
carcerated and strangulated hernia, cold water not only prevents the
expected inflammation, but also greatly assists the taxis by its contrac-
tile effects. It is when the protruded bowel is greatly distended by

flatus, that its beneficial influence is most marked Ice has also cured

aneurism.

In traumatic inflammation of the thoracic and abdominal cavities, as
contusions, wounds, etc., attended by extravasation of blood, the writ-
er's experience has led him to be decidedly favorable to the application
of cold, nor has he witnessed the production of pleurisy, or peritonitis,
which, by some surgeons, has been attributed to its use about the
trunk.

We have frequently had occasion to employ pounded ice and iced
water in uterine hemorrhage, in contused and lacerated wounds, in leu-
corrhoea, and in varicocele, with the most positive and decided advan-
tage ; and in an interesting case of arachnitis which recently came
under our observation, where by turns the patient was furious, and then
engaged in busy delirium, irrigating the head from a height with ice
water produced a powerfully sedative effect, frequently inducing sleep.

The report of Dr. Miller is restricted to two subjects, viz., Anaesthesia

804 The New-Orleans Medical and Surgical Journal.

in Midwifery, and the use of the Speculum Uteri in the diagnosis and
treatment of the diversified diseases of the female genital organs.

Having referred to the different kinds of anaethetics which have been
employed, the benefits derived from chloroform, in ordinary and extra*
ordinary labor, are briefly considered, the writer being favorable to its
use. And as to the Speculum, as it is frequently the best and only cer-
tain mode of forming correct diagnosis of disease in those parts to
which it is adapted, the writer has no morbid sensibility in speaking of
its utility. Can touch (demands Dr. Miller) detect inflammation of the
cervix 1 " This question might be answered by another ; could a blind
surgeon detect cutaneous inflammation by the touch ? The truth is,
(and every accoucheur well knows it) none of our senses is more decep-
tive than the touch, or more frequently leads to mistakes. The only
discovery which can be made by it, in the matter under consideration,
might be made as well by any other instrument as by the finger, viz.,
the existence of morbid sensibility in the cervix uteri."

Before closing his report, the writer alludes to the groundlessness
upon which Dr. Lee renounces the Speculum, and the reasons that
have led him to an opposite opinion.

A full report is given of all that relates to the Pennsylvania Hospital
for the Insane, for the past year, by Dr. Kirkbridge, embracing statistics
from the period when it was opened in 1841.

From the tables we find, that 2207 patients have been admitted, of
whom 1212 were males, and 995 females ; the discharges and deaths
1992, the deaths alone 230.

The patients at this institution are required to be engaged in husban-
dry and mechanical pursuits ; museums and reading rooms have also
been introduced as a means of improving the condition of the in-
mates.

Although various contributions have been made during the past year,
the excess of expenditures is $3,107 14 ; the average number of pa-
tients 224, and the cost per week of each $4.59.

Dr. Kirkbridge observes, at the conclusion of his report : " The in-
stitution closes its twelfth year in a state of high prosperity ; its build-
ings about as extensive as are desirable, nearly every room in all its
Wards constantly required to accommodate' those who resort to it for re-
lief, and its means of adding to the comfort and happiness of its patients,
and carrying out a liberal course of treatment,steadily rising in charac-
ter, and increasing in number and efficacy."

O. T. B.

New Orleans, March 19, 1853.

Reviews. — Dr. Lardner on Philosophy and Astronomy* 805

II. — Hand-Bdblc of Natural Philosophy and Astronomy. By Diony-
sius Lardner, D. C. L., etc. Illustrated by upwards of 200 engrav-
ings. Lea & Blanchard, Philadelphia. 1853.
This is the second of Dr. Lardner's course of publications, for popular
use, on Natural Philosophy and Astronomy, and embraces the subjects of
Heat, Magnetism, Common Electricity and Voltaic Electricity. These
important branches of science are treated in Dr. Lardner's usual felicit-
ous style, omitting, however, all or nearly all of the mathematical de-
monstrations and details essential to a complete text-book on the natu-
ral sciences. This brings the work within the limited scope of the
unscientific reader, so far as the bare facts are capable of being brought
without demonstration ; and it is thus admirably calculated to please
and instruct all those who are not particularly curious about the why
and the wherefore. There is, however, a little too much of the "royal
road" about it to please the amateur of science ; though, in this respect
it is, perhaps, less objectionable than most of the "Hand-books of Na-
tural Philosophy" of the present day.

The great value of the work lies in its being a faithful "posting up"
of all the important facts, in the physical sciences, thus far developed ;
and this is saying much for it.

Dr. Lardner is a strong advocate of the theory of the immateriality
of heat, light, electricity, magnetism and galvanism ; and maintains
that " all the different forms of physical energy, whether chemical ac-
tion, light, heat, electricity, magnetism, or visible motion and mechani-
cal power, are convertible into each other." He deems, further, that
this is all experimentally proved. He maintains that "there is no such
thing as caloric," and that the phenomena of repulsion are not depen-
dent on it, considered as an elastic immateriality. "Heat, he main-
tains, is only motion. "Heat," says he, "consists of motion, excited
among the particles of bodies." (Heat, p. 180.)

This appears very much like mistaking the effect for the cause ; for
notwithstanding all the attempts of Dr. Lardner and others to prove this
new theory, we see phenomena about us daily showing that motion,
instead of being identical with heat, is manifestly only the effect of it,
as a potent entity of some kind. If " heat consists of motion excited
among the particles of bodies," motion ought always to produce the
phenomena of heat ; but the motion of the particles of matter undergo-
ing expansion — as those of a gas or air, when the pressure is removed
— produces cold. If motion is heat, as Dr. Lardner maintains, it
ought to be uniform in its effects, like causes producing like effects.

104

806

The New Orleans Medical and Surgical Journal.

There is a great tendency, among the philosophers of the present
age, to spiritualize and immaterialize every thing.* D#. Lardner has
philosophized himself into the firm conviction, that " all the different
forms of physical energy, whether chemical action, light, heat, electri-
city, magnetism, or visible motion and mechanical power," are not
matter — not material ; they must therefore be immaterialities, or at least
spiritualities. The legitimate conclusion then is, that all the phenom-
ena of the visible universe are the results of the incessant play of a
host of spiritualities — nothings— or at least immaterialities. This looks
very much like nothing producing something — the old ex nihilo nihil Jit
being obsolete.

Professor Airy proved, some years ago, that matter consists entirely
of mathematical points ; and to this Dr. Lardner's theory seems to be
a fitting counterpart. Matter being nothing — as Berkeley had proved
long before — it was very natural, in Dr. Lardner, to assume that all the
agencies external to matter — which would be a contradiction in terms
— were also nothing, or at least not matter. The next step will be to
assert that Berkeley, after all, was right, in gravely and elaborately
maintaining that the external world was not a reality, but all a delusion
— composed, at least, of such materials as Shakspeare's dreams.

We have in our possession a copy of Euclid's Elements, in Greek,
with a Latin translation, the preface to which is dated Lutetim 4 Idus
April, 1557. The date on the title page shows that it was printed in
Paris in 1573. It is of course one of the oldest printed books in exist-
ence, and we regard it as a curiosity. Prof. Airy's doctrine that all mat-
ter consists of mathematical points merely, reminds us of Euclid's defi-
nition of a point, as given in his own words. He defines a point thus ;
2rj/xs«ov soVjv ou pspog ovfev; ; which is translated as follows: Punc
turn est cujus pars punctum nulla est : A point is that no part of
which is a point, as we translate it. Now what can that be, short of
nothing, no part of which is a point ? A point is nothing — mere po-
sition without magnitude. So that if, as Prof. Airy says, all matter
consists of mathematical points, it must be nothing, or an aggregation
of an infinity of nothings. Prof Airy, then, and Dr. Lardner, make the
universe to consist of the following substantial materials :
Mathematical points = 0
Physical energies = 0

The whole universe = 0

* Every thing but money, perhaps we should say.

Reviews. — Dr. Lardner on Philosophy and Astronomy. 307

Such is the absurdity into which philosophers run when they attempt to
lift the veil which God alone can lift.

But even admitting the whole of the theories of Prof. Airy and Dr.
Lardner, what do they explain ? Is it not, after all, merely changing
one name for another ? Suppose we admit that heat is motion, do we
then know more than we did before about the actual causes of pheno-
mena ? Certainly not.

The undulatory theory of radiant heat and light, which makes them
to consist simply of the vibrations of an ethereal fluid pervading all
space, — heat differing from light only in the length and duration of its
vibrations, — has the merit certainly of ingenuity, and of explaining cer-
tain phenomena, but not all ; and therefore we are excused from giving
it our entire adoption. The utmost that we would admit — setting aside
the materiality of light and heat — is that ttiey may be the effects of
motion, but not motion itself, as Dr. Lardner contends.

Dr. Lardner, it will be recollected, is the same one who, some years
ago, when Professor of Natural Philosophy and Astronomy in Univer-
sity College, London, most confidently predicted, ex cathedra, that all
the known laws of matter would render it an impossibility for a steam-
ship to cross the Atlantic ; and a certain learned English nobleman
most emphatically endorsed the prediction, by declaring, from his seat
in the British Parliament, that he would eat the first steamboat boiler
that crossed the Atlantic ! Of course, the impossibility was regarded
as demonstrated, after such a display of prophecy. Whether the noble
lord did actually eat the first steam boiler that went over, is not to be
found on record.

The utter failure of Dr. Lardner's prophecy was an awful shock to the
tripod of University College ; but the learned Doctor seems to have
survived the shock remarkably well — so far at least as to be enabled to
write, for the benefit of mankind, and for the especial enlightenment of
Americans, the " Hand-book of Philosophy" now before us ; in which,
we perceive, that his fondness for prophecy is in no degree abated.
At page 180 he makes a formal attack upon Mr. Ericsson's Caloric
Engine, ridiculing it, pronouncing the principle upon which it is built
" fallacious," and predicting its failure. Here again we have more
proof of the infallibility of the learned English philosopher, Dionysius
Lardner, D. C. L. ; for since the prediction was written, Mr. Ericsson
has actually navigated the Atlantic ocean with his Caloric Ship, the
principle of which being thus demonstrated to be a true one. What
Dr. Lardner will say to this, it is difficult to imagine ; but it will pro-
bably dampen his ardor for scientific prophecy considerably.

808 Tfte New-Orleans Medical and Surgical Journal.

Dr. Lardner declares that the absurdity of the principle of Mr. Erics-
son's Caloric Engine, is a " legitimate consequence of the hypothesis
that heat is a subtsance, and therefore inconvertible." It follows, then,
since the Ericsson Engine has completely succeeded, that the absurdity
lies on the side of Dr. Lardner's theory of heat, if it lies anywhere.

There are a uumber of other subjects in Dr. Lardner's " Hand-
book" which we would take pleasure in reviewing ; but the limits of
the present paper would not admit of it. Notwithstanding Dr. Lard-
ner's imperfections, his book is a valuable one, and as such we recom-
mend it to all. A. W. E.

III. — Passional Hygiene and Natural Medicine ; embracing the Har-
monies of Man with his Planet. By M. Edge worth Lazarus, M.
D. New York, Fowler & Wells, 1852.

This, as stated, is from the prolific press of Fowler & Wells, whence
emanates in a sluice such a variety of things as would make a moral,
theological, philosophical, social, hygienic, dietetic and medical museum
of the most fantastic and motly character.

Specimens : Passions of the Human Soul, by Charles Fourier ; So-
cial Destiny, by Albert Brisbane ; Love in the Phalanstery, by V. Hen-
nequin ; Children of the Phalanstery, by Cantagrel ; Consuelo and
Countess of Rudolstadt, by G. Sand ; Works of Goodwin, Barmly
and other Socialists ; Gulliver 's Travels ; Water Cure applied to every
known disease ; Hints on«the Reproductive Organs, Love vs. Marriage,
The Human Trinity, Homoeopathy, Slavery , Involuntary Seminal losses,
Universal Analogy, and the Illustrated Water Cure Almanac.

The book before us, like most of its family, a few only of which
are above designated, seem to be made up of portions of all the rest.
Indeed it is matter of surprise how so many books, with such a variety
of sonorous titles, can be made from the same staple. Doubtless it is
one of the peculiar attainments of the age in which we live. It must
not be denied, however, that this volume is somewhat specially devoted
to the advocacy of Socialism, as proposed in the Philanstery System of
Fourier. Incidentally, too, it lends its help to Homoeopathy, Graham-
ism and Spiritual Rappings.

Like all other Socialists, the author is severe upon civilization, mo-
rality, and all the laws and usages of society as it exists. Nor is he
mild upon some who have zealously, but very unsuccessfully, endeavored

Reviews, — Dr. Lazakus on Passional Hygiene. 809

to " follow in the footsteps of their illustrious predecessors," Fourier,
Brisbane, &c. Witness the following, pp. 208-69 :

"Whoever speaks of industrial organization without a perfect recognition of the
triune law of distribution, attested by all the known harmonies of the universe, is
completely innocent of social science, and has no affiliation with Fourier or Phalan-
sterians other than that extended by mere courtesy. It is to the ignorance of this
fact is due the disastrous misconception of the American public, through the abuse of
the term phalanx by absurd little associations in various parts of our country, aided by
the unfortunate defences of false friends among our smart, superficial charlatans of
the press, such as Horace Greely and other mere civilized moralists."

Et tu Brute !

That he would not do things by halves, in a communist way, we
might prove by quotations respecting the intercourse of the sexes ; but
as these would be inappropriate until the 'instincts of Harmonic lifej
through the serial progression of planetary unity shall elaborate the
Trinity of Incarnation and in Industrial Organization, — by the fusion of
individual rights and interests in their corporate spirit, by the equili-
brium resulting from judicious interchanges, in operating by short ses.
sions, and by the enthusiasm created in defense of collective unity ; we
say, until these multiform and doubtless potent agencies shall have
changed the order of things and the tastes of our readers very decidedly
from what they are known to be, in this age of social subversion and
civilized degeneracy, we think it better to forbear.

On another matter of much importance, and which costs the family
and the state, both solicitude and treasure, we cannot refrain from giv.
ing a glimpse of the new light.

Discoursing upon the " Little Hordes," whom he, quoting from Fou-
rier, denominates " the soldiery oj God" "preservers of social honor,"
&c, he says, page 281 .

" In order to obtain such prodigies of virtue from childhood, it would seem neces-
sary to recur to supernatural means, as our monastics do, who by very severe novici-
ates accustom the neophyte to abnegation of himself. However, the opposite
course will be followed ; with the Little Hordes only the stimulus of pleasure will be
employed.

Let us analyze the sources of their virtues ; they are four, and all reproved by
moralism ; namely, the love of dirt, pride, impudence, and insubordination. It
is by giving themselves up to these pretended vices that the Little Hordes elevate
themselves to the practice of all the virtues. Let us examine this, availing ourselves
of an infallible guide: [the analysis and synthesis of passional attraction.]

I have said that the theory of attraction must confine itself to the one end of mak-
ing useful the passions such as God gave them, and without changing any thing. In
support of this principle I have justified nature in several attractions of an early age,

810 The New-Orleans Medical and Surgical Journal.

which have seemed vicious ; such are curiosity and inconstancy ; their true end is
to attract the child into a number of seristeries in whicb his natural vocations may
develop themselves. Such too is the propensity to seek the company of older black-
guard boys ; because from them, in harmony, the child receives the impules and the
charm which draws him on to industry (ascending emulation, chapter XIX.) Diso-
bedience to parents and preceptors is another ; because they are not the ones
who ought to educate him ; his education should be effected by the cabalistic rival-
ries of the groups. Thus all the natural impulses of early youth are good, and even
those of more advanced youth, provided they be exercised in passional series."

The capitals are ours, and used only to indicate with greater force
the four or five distinguishing virtues which, from the days of Adam to
those of Fourier, have been so differently regarded by both the wise
and unwise ; the good, bad and indifferent of the human family. This
is only a sample.

As a specimen of the vegetarian philosophy which this hygienic trea-
tise embodies, and a very fair one, we think, both as regards perspicu-
ity of style and soundness of doctrine, take the following from pages
50, 51 and 52.

" After all, the essential fact is that of communion and interchange of benefits,
according to the most approved formulas of self-appropriation, which in the commu-
nion of the social affections may become the most devoted love.

Our food does not nourish us truly, does not supply force to our muscles, senses, af-
fections or intellect, except by the aromas which we elaborate from it, until it thus
becomes the same invisible, or at least unseen neuro-magnetic fluid which passes
from one living body to another. This is the essence of the blood, as the blood is the
result of the aliment. Thus by nourishing ourselves from living rather than from
dead bodies, we economise the time, trouble and expense of force in killing, cleaning}
cooking, serving, masticating, digesting, and absorbing them into our blood, and we
get the vital influx of power and affection by direct communication of their nervous
systems with ours.

We are instinctively sensible of this advantage, especially children, of whom is the
kingdom of heaven. Thus, as soon as we individualize an animal, and come into
personal relations of use and pleasure with it ; as it is with dogs and horses, with the
child's pet lamb, calf, kid or chicken, we are outraged at the proposal to kill and
eat it.

We are eating it already every day in a finer form. We feed on it aromally, i. e.}
spiritually and materially at once, in a compound manner ; since the aromas, such as
heat, light, electricity, galvanism, magnetism, the nervous aura, are the blending
points of harmonic expression between spirit and passion, and integrate them in living
beings. They form the practical element in the solar trinity, in which the active, ca-
loric or love element is found working in the material world of concrete beings, under
the guiding influence of light, or the intelligence of law."

Clear as mud ; much clearer than the bulk of the volume, or any of
its " associated series for do we not herein perceive, that in cases

Review. — Dr. Lazarus on Passional Hygiene. 811

of shipwreck or other disasters, by which food of the ordinary kind is
unattainable, and so many lives for want of this new light-house have
been lost by starvation, it will hereafter only be requisite to ascertain the
" most approved formula of self-appropriations," in order to enjoy that
" communion and interchange of benefits" which seems the higher or-
der of nourishment and enjoyment, and can continue it " day after day,
week after week and year after year" ? In other words, a few pet ani-
mals, be they dogs, lambs, calves or poultry, and we suppose if the fam-
ishing be not Jews— swine, also, will, under this formula, constitute "the
practical element in the solar trinity" by which they shall not only be
nourished indefinitely by and among themselves, but with a vast economy
of time, fuel, ironmongery, and wear and tear of digestive machinery,
shall also sustain "spiritually and materially, at once and in a compound
manner," after the most agreeable aromal fashion,^all the integrated be-
ings around them. Viewing this as a sane idea, this formula would be
worth knowing ; but after pretty diligent search, we have not been able
to find it in the copy before us.

Having glanced at a very few of the many follies contained in this
and similar volumes, whose authors seem to expect to cover up and
conceal the shallowness and incoherence of their philosophy and the
meagreness of their scientific researches, by the jargon of technics and
the dust and splutter of their unjust and ribald censures of every thing
valuable and of good report, we turn with pleasure to the one redeem-
ing feature amidst the general and repulsive deformity of the picture*
Upon the "Public Health of Cities," our author is decidedly more clear
and practical than on aught else of which he treats. On pages 416 —
17-18 he says :

'? Societies in which such combinations had acquired the ascendency in numbers ?
or even without superior numbers, the ascendency in legislative power, on account of
the unity of their action, can quickly strangle those conspiracies against the life and
well-being of the people, which laugh at the feeble good intentions of our so-called
reformers. Conspiracies, did I say? Yes , every organized public temptation to vice
is a conspiracy. What plot of treason or murder ever did the thousandth part of the
mischief of our bar-rooms and grog-shops, where the adulterer or manufacturer of
false wines and brandies is in league with the retailer, and a covey of sots always on
hand act as purveyors of custom ?

Individual liberty demands the suppression of public temptation to vice in all its
forms, and there is no truer step in real liberty than the prohibition of the retail liquor
trade.

It is already recognized that slaughter-pens, distilleries, tallow chandleries, gas-
works, and other establishments, however useful, which offend against the senses of
the mass of citizens, become local nuisances, and are amenable to the municipal au-
thorities, and subject to removal on complaint of neighbors. Nor is any citizen per-

812 The New-Orleans Medical and Surgical Journal.

mitted to keep dangerous beasts on his premises, as a tiger, a panther, or even a bear,
although chained. If then we admit legal guarantees in favor of the senses, we owe
them for a much stronger reason to the social affections, and where have these to fear
a more ruthless enemy than the grog-shop, or a greater nuisance than drunkenness,
or a more dangerous wild beast than the drunkard IV

The queries put by him in these quotations are in the highest degree
pertinent and solemn. In this city we have had enough and more than
enough, of families ruined, a treasury drained by expenses inseparable
from the police and criminal establishments rendered essential by grog-
shops, of savage murders committed within their walls, of corrupted
suffrages, broken hearts and prostrated intellects, to make us cry out
with one united voice for deliverance from these conspiracies against
our public and private welfare.

Honor to whom honor is due.

We are indebted for the volume before us to Mr. J. C. Morgan,
whose enterprize keeps before his customers and the New Orleans pub-
lic a variety of the newest and rarest issues of the modern press, both
in its periodical and permanent literature. J. S C.

V. — Maclise's Surgical Anatomy ; with additions from Bourgery, etc.

Edited by R. U. Piper, M. D. Boston and London, 1833.

This Par^ which is the first one issued by the American Editor, con-
tains plates representing the form of the thoracic cavity, and the posi-
tion of the heart, lungs and larger blood vessels. In plate Second, the
surgical form of the superficial cervicle and facial regions, and the rela-
tive position of the prmcipal blood-vessels, nerves, etc., are very well
represented, and accurately described in the text. To add to the force
of the illustration, some of Bourgery's plates, descriptive of this part
of Surgical Anatomy, has been here introduced by Dr. Piper. They
greatly enhance the usefulness of the work, and will therefore be duly
appreciated by the American student of Anatomy.

We are not advised as to the number of " Parts" to which this work
is to be extended ; we presume, however, they will be continued until
we shall have a complete picture of Surgical Anatomy, at which time
we shall be the better enabled to judge of the merits and advantages of
such a work at this time.

Review. — Dr. Fishbough on Macrocosm and Microcosm. 813

IV. — The Macrocosm and Microcosm, or the Universe Without and the
Universe Within, being an unfolding of the plan of creation and the
correspondence of truths, both in the World of Sense and the World
of Soul. In two Parts. By Wm. Fishbough. New York, Fowler
& Wells, 1853.

As this seems to be only a part of the whole, and in its " present
stage of development" rather beyond the scope and verge of minds not
trained in the school to which it pertains, it would be improper, and
might be unjust, to venture upon any extended examination of its doc-
trines at present. Suffice it to say, there are evidences of vigorous
thought and commendable research, though unchastened by that homely
and useful handmaid of all science— common sense.

Our author sets out in his preface, page 4, by claiming a discovery,
as follows :

" I have ventured to hope that this defect in the mode of philosophizing might
prove to be in some degree supplied by a discovery, the fundamental principles of
which came into my mind some four years ago, in a manner quite extraordinary,
but of which I need not now speak particularly. This discovery, which I have called
' the law of the seven-fold correspondential series,' or ' the harmonial scale of crea-
tion,' is to some extent unfolded and applied in the present volume, though but a small
portion of the evidences of its truth and instances of its applicability are herein ex-
hibited.

The main idea embraced in the discovery referred to is, that each complete system
or sub-system of creation, however great or small, is resolvable into seven serial parts
or elemental degrees, corresponding to the seven notes of the diatonic scale ; that as
composed of such parts, the systems are arranged side by side, or have one above
another, as so many octaves, corresponding to the octaves in music ; and that like
them, each one serves as a general exponent of all the others, whether on a higher or
lower scale. This idea, with its natural adjuncts, of which I cannot here speak par-
ticularly, by harmonizing and unitizing all natural series and degrees of creation,
also clearly illustrates the fact that all truths are involved in and evolved from one
grand central Truth ; that they are indeed but parts and degrees of that one funda-
mental truth, which are ultimated in the various forms of embodiment which compose
the sum total of created existence. By pursuing the method of reasoning which this
idea unfolds, I have endeavored to make one portion of the system of nature expose
the secrets of another, and caused visible facts and invisible principles to mutually
cast their light upon each other."

Paracelsus proclaimed his elixir, and pronounced the principles of the
medical art wholly erroneous. Brown resolved every ill to which
flesh is heir, into two diseases, and restricted their treatment to the
use of owe remedy. Broussais, reversing his order, taught one disease
and two remedies. Hahnemann, " the sage of Coethen," summa*

105

814

The New-Orleans Medical and Surgical Journal*

rily dispenses with all reasoning and all material remedies ; substituting
in their stead the veriest nothing that an infinitesimal intellect ever
groped after ; but here is an idea. This " law of the seven-fold corres-
pondential series," is most incontrovertibly musical, and must, we think,
be something of which Solomon had not obtained possession when he
delivered his opinion on novelties. We know he had " men singers
and women singers," perhaps equal to our modern minstrels in voice
but by no means so in their philosophy.

The superiority of modern to ancient and divine inspiration, is fur-
ther assumed in the following short paragraph:

" But let me not be understood as arguing that the matter of this universe was cre-
ated by God out of nothing. The mind cannot conceive of any such thing a§ no-
thing, or of something coming out of nothing , and therefore the idea may be at once
dismissed from the mind as being itself a mental nothing. But if we suppose that
spirit is an essence, and that matter, as such, was created out of this essence, there
will at least in this be no violation of the laws of thought ; and the reasons on which
such suppositions may be grounded will incidentally and more distinctly appear as we
proceed."

We suppose it to mean that the Infinite Creator could make a world
out of material, or its equivalent, previously existing, but could not
make all things of nothing, as Moses declares he did. We cannot of
course enter upon this question here. Suffice it, that the most rabid
of the infidel school of Geology would be loath to approach so intim-
ately the mselstrom of Atheism.

However, it will be but fair and just to allow the author the benefit of
one of his luminous explanatory paragraphs on this point. We extract
from page 53.

,e But as the animal kingdom, physically speaking, was previously contained in the
vegetable, and the vegetable kingdom was contained in the mineral, and so on
throughout the descending scale, so the great original universal kingdom of unformed
matter, and whose undeveloped properties and principles were typical of al 1 subsequent
and subordinate kingdoms, was itself as one kingdom, previously involved in the infi-
nite, eternal and unoriginated kingdom of spirituality, which, as before shown, consti-
tutes the Divine Spirituality. This Kingdom of Spirituality — in other words the Di-
vine Personal Being — comprises therefore not only the material or substantial, but the
spiritual and volitional, and hence the entire elements of the Cause of all things in
universal creation ; and hence the Creator and the created must stand as mutual ex-
ponents of each other."

For the benefit of musicians, especially those who are fond of in-
vestigations into the laws and serial harmonies of this outer world, we
subjoin the following from pages 58—9.

Review. — Dr. Fishbough on Mocrocosm and Microcosm. 815

" But we have seen that Nature, as a whole, is divided into many systems, king-
doms, or more properly speaking, Discreet Degrees, rising one above another. Each
one of these kingdoms or degrees (as will gradually be illustrated in what follows)
contains within itself the seven-fold series of parts, as the natural evolution and pro-
duction on a higher scale of the seven-fold series of the degree or kingdom immedi-
ately below it in the order of development ; and all of these, separately and collect-
ively, are evolutions from and correspondents of the divine seven-fold constitution'
which is the Originator and Cause of all. Each one of these seven-fold series, more-
over, corresponds to the diatonic scale in music, and which, with its seven constitu-
ent notes, is therefore its natural oral interpreter and exponent. Thus the various de-
grees or kingdoms of natural development may be considered as octaves, rising one
above another, the same as the octaves in music. Each octave exactly corresponds
to, and harmonizes note by note, with all other octaves, whether they be on a higher
or lower scale ; so that if we fully understand any one octave, degree or kingdom of
natural development, we have in it a measure and exponent of all others. Thus the
system of Nature, as a whole, maybe considerod as one grand Musical Organ, com-
passing all these octaves, and which in the hands of the Divine Organist, the Divine
Being, in whose infinite series of octaves of Love and Wisdom exists the very soul
and origin of all harmony, is capable of sending forth everywhere those silent notes
of harmony and music which have been perceived and deeply felt by every truly ele-
vated and interiorly developed human soul !"

Again, on pages 66— -67, we have a continuance of this musical the-
ory, blended with other curious notions respecting the attributes, power
and functions of God.

" With respect to the origin, structure, laws, etc., of the universal cosmical system,
we commence our reasonings with a postulate which, whether strictly true or not*
cannot lead us into important error in our subsequent deductions, since we have so
many correctives of inharmony, as involved in the general series of corresponding and
harmonious octaves of developments through which the path of our investigations
will lead us. The postulate is that God, from the promptings of his own interior
soul, which is Love, under the direction of his Wisdom, which gave order and form
to the operations of Love, formed from the most exterior, or if the expression may be
allowed, the least divine and most nearly physical portion of his own personal emana-
tions, as many degrees, varieties, or perhaps classes of atomic particles as corresponded
to the general seven-fold harmonies of his own Infinite nature. The supposition that
the varieties of these primitive atoms are in number just seven, or a multiple of seven
is admitted to be purely a priori, but is a legitimate deduction from principles before
established."

Here we have the honest acknowledgment, that this theory of a har-
monious, universal, cosmical system of serial developments, correspon-
dential affinities and diapasonic dependencies, is, if not purely fanciful,
at least uncertain, even in the judgment of its enthusiastic discoverer.

The book, in many respects, possesses merit ; and we can only re-
gret to witness the eccentricities of a fine but unstaid intellect, as man-

816

The New-Orleans Medical and Surgical Journal.

ifested in its pages. We sincerely hope the succeeding part — or Mi-
crocosm, may not only in itself, be liable to fewer objections, but may
also correct some of the errors of its predecessor.

The volume is on sale by J. C. Morgan, to whose courtesy we owe
our acquaintance with it. J. S- C.

V. — Proceedings of the Texas Medical Convention.

From the proceedings published by the Convention, we learn that its
first meeting was held in the city of Austin on the 17 th day of January,
1853, when Dr. S. K. Jennings, of Travis, was called upon to preside
over the Convention, assisted by the following Vice Presidents : Drs.
J. Taylor, W. A. Morris, and J. Gaines. Dr. A. J. Lott was ap-
pointed Secretary.

On motion, thirty-five members registered their names as members
of the Convention.

The Convention adopted the title of " Texas Medical Convention,'*
by which it is to be hereafter known. It sat three days, and adopted
a good Constitution and a well digested set of By-Laws.

Dr. James Gaines, of Milam county, was chosen orator, to deliver
the address at the next annual meeting of the Association.

Our sister State, Texas, which possesses agricultural and commercial
advantages not inferior to any in the South or West, begins to develop
also her intellectual resources ; and the Medical Profession of that
Stale already rivals, in talent and mental endowments, many of her
elder sisters. She may indeed boast of her Smiths, her Massies, her
Heards, and others, personally unknown to us, but who are destined,
we verily believe, to adorn and extend the reputation of the profession,
far beyond the boundaries of their adopted State.

Our list of subscribers in Texas, now daily increasing, induces us to
believe that the Medical profession of that rich portion of the South,
is fully aroused and determined to keep pace with the progress of me-
dicine.

We have more than once enriched the pages of this Journal with
papers, essays, &c, written by some of the eminent practitioners of
Texas ; and we trust we may be favored in future with the experience

Review, — Transactions of the Kentucky Medical Society. 817

and observation of others, whose modesty may have prompted them to
withhold fheir names from the public.

Medically, we regard Texas, as she is topographically, a part and
parcel of Louisiana ; and we therefore hail her efforts in the cause of
medical progress with sincere pleasure and the most unalloyed satis-
faction.

VI, — Transactions of the Kentucky State Medical Society, October,
1852. Louisville, Ky.

This Society held its second annual meeting in the city of Louisville, on the
20th October 1852, the President, Dr. W. L. Sutton, in the chair. Over sixty-
five members appeared and took part in the proceedings of the Society. Three
days, of two sessions each day, were consumed before the Society brought its
proceedings to a close.

The special committees were as follows for the next annual meeting :

1. On Medical Biography or the lives of meritorious or distinguished Phy-
sicians or Surgeons of Kentucky, Dr. Breckenridge of Louisville.

2. On Medical Literature, or the history of the medical authorship of Ken-
tucky, Prof. L. P. Yandell.of Louisville.

3. On the relation between diseases and particular geological formations, Dr«
Peter, of Lexington.

4. On the Statistics of Hernia, Dr. S. B. Richardson, of Louisville.

5. On the Statistics of Lithotomy and Calculous Diseases, Dr. Gross, of
Louisville.

6. On the History and mode of management of Hospitals, Dr. Raphael, of
Louisville.

7. On the history and mode of management of Penitentiaries and Prisons,
Dr. W. C. Sneed, of Frankfort.

8. On Suits for Mal-practice, Dr. Spillman, of Harrodsburg.

9. On the Results of Surgical Operations in malignant diseases, Dr. Cole-
scott, of Louisville.

10. On Epidemic Erysipelas, Dr. Owen, of Henry county.

11. On Epidemic Dysentery, Dr. Hynes, of Bardstown.

12. On Typhoid Fever, Dr. Fry, of Louisville.

13. On Placenta Praevia. Dr. Miller, of Louisville.

14. On the Statistics of Remedies in Disease, Dr. Lewis Rogers, of Louis-
ville.

This part of the business over, the President, Dr. Sutton, delivered a very
handsome address, " On our duty to the profession, and our duty to the commu-
nity in which we live.'''' Throughout it is characterized by elevated sentiments,
good sense, and a genuine love for the honor and prosperity of the medical
profession— many parts of it are too fine to be passed over with a casual notice,

818 The New-Orleans Medical and Surgical Journal.

but our space is too limited to permit us to give extracts from this address. It
should be read by the entire profession.

The Transactions number over 130 pages; are handsomely printed, and many
of the subjects reported on by the various standing committees, are illustrated
by well executed maps, diagrams, etc.

Kentucky never does any thing on an insignificant scale ; and the labors of
her medical men (vide Transactions) give abundant evidence of the industry
and intellect which are being applied to the elucidation of her medical and sur-
gical history.

These Transactions embrace " Reports" on the following scientific subjects,
all of which are elaborate, well digested, and of the highest interest to the
profession, viz :

1st, On Vital Statistics ; 2d, Medical Ethics ; 3d, Obstetrics ; 4th, Specu-
lum Uteri ; 5th, on "Registration ; 6th, Affections of the Head ;„ 7th, Affections
of the Spine ; 8th, Affections of the Neck and Chest ; 9th, Affections of the
Abdominal Organs; 10th, Affections of the Pelvic Organs ; 11th, Elm Bark
as a Surgical Agent; 12th, Amputation; 13th, Traumatic Tetanus; 14th}
Exsections; 15th, Plastic Surgery ; 16th, Tenotomy; 17th, Army Surgery ;
18th, Surgeons and Physicians of Louisville ; 19th, Affections of the Extrem-
ities ; 20th, the Bandage as a Therapeutic Agent ; 21st, Affections of the Ge-
nital Organs in the male ; 22d, Affections in the Genital Organs in the Female;
23d, Affections of the Arteries; 24th, On Indigenous Botany ; 25th, On Epi-
demics ; 26th, On the Cholera in Lexington ; and lastly, report of the commit-
tee on Case Book.

From the above list, the reader will perceive that the reports of the various
committees covered an immense field of observation and practice ; and faith-
fully have they discharged the arduous duties assigned them. Some of the
cases and observations contained in these reports are so instructive, and others
so unique, that we are tempted to lay some of them before our readers, in the
appropriate department of the Journal. In our future numbers we shall have
occasion to refer to the mass of facts embodied in these highly interesting
Transactions of the Kentucky State Medical Society.

In conclusion, we may state that in medicine, as in every thing great and
noble, Kentucky is equal to any State in this glorious Union.

Reviews. — Addresses, Reports, etc*

819

VL — Lectures on the Science of Life Insurance, addressed to families^
professions, etc. By Moses L. Knapp, M. D., Secretary of the
Fraternal Mutual Life Insurance Company, late Professor of
Materia Medica of the University of Iowa, etc.
New Views on Provisional Callus. By Frank H. Hamilton*
A. M., M. D.

Hydatids of the Liver. Operation and Cure. By Edward We-
ber, M. D. From the New York Medical Times. New York,
1852.

The Necrological Appearances of Southern Typhoid Fever, in the
Negro : with hints upon its Prophytaxis and Therapeutic man-
agement. By H. A. Ramsay, M. D. Colombia County, Ga.
Dr. Knapp has again presented us with lectures on Life Insurance in an
official capacity — that of Secretary of the Fraternal Home Mutual Life Insur-
ance Company.

In these lectures the advantages of life insurance are fully set forth, its ori-
gin stated, rate of mortality presented, with the practices of different compa-
nies, the mode of conducting examinations, medical jurisprudence considered
in relation to insurance, its moral influence upon society, etc., etc., all of which
lead, under the guidance of Dr. Knapp, to the happiest results, which may be
included in " the blessings of life insurance."

Without questioning the advantages which not only may, but actually do
arise in a vast number of cases, to the insured in properly and fairly conducted
companies, we are far from believing that some of the " general principles" ad-
vanced have any thing to do with life insurance ; such, for instance, as that
" the early Christians appear to have been the first life insurance company,"
and that the principle was adopted and practised by them when they sold off
their individual possessions ; and also " the principle received the sanction of
the Apostles and the Divine approbation." This surely is claiming much
greater antiquity for life insurance than would be demanded by the insured,
who, properly and justly regarding it as a matter of business — a secular affair,
for which, upon payment of certain sums of money, the quid pro quo, at some
future time, will to the parties indicated, be given ; and should the advantage
be as stated by the writer, the " return of the sums invested, with compound
interest," it would merely be presenting an additional claim for human "appro-
bation;" since it cannot be denied that the Apostles work on earth, having
received their appointment from their Divine Master to go and preach the gos-
pel to all the world, was to draw the minds of their hearers from all earthly
considerations, to preach Christ and him crucified, and to fix their affections
upon heaven and heavenly things, and to ascribe to them the sanction and ap-
probation of the principles of well or ill regulated insurance companies, would
be to suppose them capable of violating the express commands of Him in whose
service they were engaged, and of essentially minding earthly things. Again
we read in the lectures, that " Ananias, with Sapphira his wife, sold a posses

820 The New-Orleans Medical and Surgical Journal.

sion, and brought a certain part only of the price and laid it at the Apostles
feet," for making a reservation of part of the price and thereby practising de*
ception and fraud, Ananias was first stricken dead, and when Peter, about
three hours after, demanded of his wife, whether they had sold the land for so
much, and her answer was yea, for so much, that she likewise straightway fell
dead at his feet ; and for what were these two persons instantly visited with so
signal a mark of the Divine displeasure ? Obviously for practising deception
with sinister motives and attempting concealment by a lie* This being, we
think, the proper construction'of the passage referred to, in what particulars, we
ask, can it be discoverable that the principle of life insurance certainly received
the sanction of the Apostles and the Divine approbation ? Assuredly no such
warrant can be found in the case cited— not even with the sincere conviction
of Dr. Knapp to sustain it !

The first life insurance company was established in England, under the name
of the " Amicable Society for a Perpetual Assurance Office," in the year 1706,
and the first in the United States, under the name of the " Protestant Episcopal
Association," in Pennsylvania, in 1769. What, may we enquire of Dr. Knapp,
became of the principle and practice of life insurance during this long interreg-
num— more than seventeen centuries ? — upon which head history and the wri-
ter himself have left us to conjecture. And why, having met with the Divine
approbation in the early ages of Christianity, is there no connecting link for so
many hundred years ? We are forced to the conviction that Dr. Knapp, hav-
ing mistaken the application of his text, his darling pet, over which he watches
with so much solicitude — life insurance — cannot claim so great antiquity, but
that being of man's invention and for man's benefit, the society of which he is
secretary would be no less potent for good, no less extensive in the blessings
which it diffuses, and in the moral influence which it exerts— be that great or
small — had he rested its claims to public favor and patronage — upon which fa-
vor and patronage, we apprehend, mainly rests the ability of all insurance com-
panies to dispense tangible evidence of their good to society — upon its own in-
trinsic merits.

Life insurance is certainly, we think, an excellent thing ; we also think,
that when Doctors publish lectures upon the subject, they should at least in.
sure their readers against the follies of antiquity i !

Dr. Hamilton, entertaining somewhat new views on the formation of Provi*
sional Callus, has placed them before the profession. The process of repair
and reproduction after injuries of bone, have received, we are informed, the es-
pecial attention of Dr. Hamilton, and after a personal examination upon the
living subject of nearly 600 cases, added to observations upon pathological
specimens, have led him, for the most part, to discard the doctrine of Dupuy-
tren on this subject, and to coincide mainly with those of Mr. Stanley and Mr .
Paget ; indeed had it not been for a series of lectures which were delivered by
this last named gentleman, containing an exposition of his views of the union

Reviews.— "Addresses, Reports, etc.

821

of broken bones, the writer would have regarded his own as original, but time
and chance happening alike to all, Dr. H. brings his observation and experience
to sustain the modern opinions of others, in the following language :

" While prosecuting my investigations for the purpose of ascertaining the average
results in the treatment of fractures, several other points of interest have been sug-
gested, some of which I have sought carefully to determine ; that which arrested
my attention earliest and which I have most attentively noticed all along, until I
have at length reached a satisfactory conclusion is, the almost constant absence of
provisional callus, both during the process of cure and in the result, where the frac-
tured ends have been kept in tolerable apposition, and free from all undue ex-
citement.

Although it has not escaped the observation of many shrewd writers that Dupuy-
tren's experiments were all made upon brute animals, and they have therefore re-
ceived with a prudent caution mauy of his conclusions, such as the period of time
occupied in the several stages of reparation, the sources of the callus, etc., yet has
it seldom if ever happened that they have called in question or expressed a oloubt of
the accuracy of his conclusions as to the main point, viz : the existence of a
provisional callus as a temporary bond of union in all cases where bones unite by a
natural and undisturbed process.

I think it is obvious that Mr. Liston had noticed the absence of provisional callus
in simple and well-adjusted fractures, at least soon after the union was completed ;
a fact for which he offers the usual explanation, viz : that it is absorbed soon after
deposition ; yet he does not recognize its inconsistency with his preceding statement
that in such simple fractures the ' effusion is limited to the divided parts/ But the
fact that he had not noticed the presence of provisional callus even during the progress
of restoration, seems probable from his account of what occurs in the opposite class
of cases, where * displacements,' etc., exist, for there is now, he informs us, « great
effusion of new matter or callus.' The terms callus or new matter being here first
employed."

Mr. Stanley, in the preface to his " Treatise on the Diseases of Bones,"
says :

" Experiments in animals have not accomplished so much for the elucidation of the
reparative process of bone in man as might probably have been expected ; the cir-
cumstances attendant on the fractured or necrosed bone in man, are essentially dif-
ferent from those of the experiment of breaking, or causing the death of a bone in
animals ; thus around the fractured bone of an animal, the deposit of cartilaginous
and osseous substance, which has been designated provisional callus, is of uniform
occurrence. But in the human subject no such cartilaginous and osseous deposit uni-
formly takes place around the fractured bone ; here therefore it is not a part of the
reparative process."

Dr. Hamilton goes a step beyond, and observes :

" I am now prepared confidently to affirm that the so-called provisional callus ne-
ver constitutes any part of the reparative process in the union of divided bones,
when all those circumstances of simplicity, apposition, quietude, health, just manage-
ment, etc., obtain, which may properly be considered essential to a normal process ;
that bones unite most naturally by definitive callus, and that provisional callus is ac«
cidental and secondary ; the result probably of undue excitement alone."

106

822 The New-Orleans Medical and Surgical Journal.

If the amount of provisional callus in any way depend upon the mobility of
the parts, then will its presence be more manifest in animals of the brute cre-
ation than in the human body, on account of the much greater difficulty of
preserving the bones in apposition. In fracture of certain bones invested with
synovial membrane, as for instance, the neck of the femur, the formation of
callus is less uniform, even if it be present at all ; and in fracture of the cra-
nium, with no motion of the bones and little soft part to put on inflammatory
action, union may generally take place without the provisional callus, but with
regard to the union of bones at other parts of the body, the authority of sur-
geons is, we think, vastly against the opinions of Dr. Hamilton ; in those cases
of fracture, where the bone and its investment are simply divided and mispla-
ced, and quietly put in opposition, thereby preventing much inflammatory ac-
tion and effusion, there will most probably be no perceptible deformity at the
point of union, the new matter having been absorbed ; but as, for the most part,
divided bones occur under less favorable circumstances, there being much dis-
placement, and very frequently extensive injury to the soft parts, callus will
\ generally be found.

The opinions of Dr. Hamilton and Professor Paget are well worthy of care-
ful consideration and observation, upon which ground their doctrine must either
be definitively settled, or not being sustained by this test, will, after the lapse
of time, cease to be entertained.

HYDATIES OF THE LIVER.

A remarkable case of Hytadids of the Liver has been published by Dr. We-
ber. The subject was a German, aged 26 years, who resided in the State of
Illinois, where the case was diagnosed and for some time treated ; at length the
patient went to New York, where the previous diagnosis was concurred in by
several physicians, and on the 19th of May, 1851, the operation was commen-
ced bv introducing a trochar, and through the canulla a fluid resembling whey
passed; an incision was then made down to the liver, which was punctureds
with the same result as when thrust through the integuments ; no hemorrhage
occurred, and the patient was placed in bed.

On the 5th of June the second operation was commenced, and a fetid fluid
evacuated, in which were fragments of broken cysts floating ; microscopic
examination, in the presence of a number of medical gentlemen, led to the
conviction that they were the remains of the true hydatid cysts. The opening
being enlarged, entire cysts flowed out in large quantity; at this time there was
hemorrhage. Subsequently, at intervals, fluid, varying in quantity from three
to twenty ounces, was evacuated ; and in the beginning of October, there re-
mained but a small fistulous opening. This, in January, 1852, entirely closed,
and the patient, who had become much emaciated, was in a short time en-
tirely restored to health.

Reviews. — Addresses, Reports, etc.

823

In his sketch of Southern Typhoid Fever in the Negro, Dr. Ramsay has,
in few pages, thrown much interesting matter, occasionally halting by the way,
and giving reins to a somewhat exhuberant fancy, to remind some Southern
journalists of the error of their ways, in prostituting their periodicals to cliques
and colleges, and in building up some new, and putting down others, without
regard to the quality of the material. " Village doctors" are sometimes con-
sidered out of place, Southern Medical Literature contained within very lim-
ited foci, and the alumni of its schools, seemingly moved " by an insatiable
ambition of an immense magnitude, respecting neither truth or fairness."

These are rather sweeping denunciations, and require specification by the
writer in order to render them individually interesting, but perhaps they were
made at random, the Doctor having no " delight to pass away the day" upon
a single subject, without indulging in the "pleasures of imagination;" but as
we are not able to decide upon the merits of his case (which the reader is left
to guess at), we shall at once throw ourself into a feverish state — the type of
which will be typhoid.

The present paper is intended as an addendum to an article upon Southern
Typhoid Fever, by Dr. Ramsay, which is now passing through the press, and
which fever is, in the opinion of the writer, a disease sui generis, none other
possessing the same pathological phenomena, or the same diversity of living
symptoms ; and further, the glands of Peyer and Brunner being more affected
and enlarged in the Southern negro than in the northern subject.

From autopsies made by Dr. Ramsay, he has arrived at the opinion, that the
brain, lungs and heart of the negro are smaller than those of the white man,
whilst the liver, kidneys and glands are larger.

The nervous system, with reference to sensation, is less developed than in
the white, which may render them less susceptible to convulsive affections.
In continuation of his subject, the writer observes, " To confirm this opinion,
we appeal to our morbid preparations, our autopsies and our observations, as
well as the reports of others, who have made autopsies in colder climes, which
differ from ours, not in the "essential seat of the disease, but in the prominence
and development of the glandular affection. We do not wish to be understood
as saying, that Typhoid Fever South, differs in its pathological location from
the same disease North, but only in its development, which we conceive is
controlled by topographical, meteorological, hygrometrical, and other causes,
inducing a modification of symptomatology, and a corresponding change of
treatment."

Dr. Ramsay passes over the abortive treatment of this fever with quinine
in silence, and urges the importance of keeping the bowels in a state of quie-
tude. "To purge is to kill; to bleed is death." When laxatives are used, they
should be of the blandest character; to conduct the disease to a successful
issue> medication should be sparingly employed.

In mental capacity, the negro is regarded by the writer as so very inferior,
that education can do little for him ; he observes, " Every ingenuous mind in
the South knows, that African intellectual progression is beautifully slow, and

824

The New-Orleans Medical and Surgical Journal.

intensely dull, in this country ; from present appearances, predicated upon sci-
entific researches, it will probably remain in statu quo by irrevocable destiny.
We believe that the negro succeeds better in agticulture and medicine, than
any thing else."

This, however, is a departure from the subject of disease, and one upon
which most Southern readers have, we imagine, already formed an opinion*
though that opinion may not be so annihilating to every elevating thought,
every ennobling sentiment, every purifying affection, as that which consigns
them to darkness without hope— a darkness fixed " by irrevocable destiny."

G. T. B.

New Orleans, April 7, 1853.

VII. — Remarks en Osteo. Aneurism — with a case involving the Condyles
of the left Femur. By J. M. Carnochan, M. D. With Plates.
New York, 1853.

Dr. Carnochan's feats in Surgery are building up for; him a lasting fame all
over the country, because he enters thoroughly into the merits of his subject ;
studies it with care and patience, and describes it with accuracy and force.
His operations on the jaw have shed no ordinary lustre upon American Sur-
gery ; and scarcely had we ceased to wonder at and admire these achievements,
when we are again directed to his novel case of " Osteo-Aneurism. " Speak-
ing of this latter disease, he remarks :

" The first description of this disease dates no further back than the close of the
last century, when Pearson of England, in 1790, and Scarpa, in 1792, reported each
a ease of this disease of the osseous tissue. More than a quarter of a century elap-
sed before any new facts were reported ; and it was not until the year 1826 that sci-
ence was again enriched by the observations of Dupuytren, Lallemand and Breseheb
on the pulsatory tumors of the bones. More recently, cases of pulsative tumors of
the bone have been furnished, principally by MM. Roux and Velpeau, of France; and
by Liston and Handy side, of Scotland ; but it is to be inferred from the descriptions
of some of these cases, that they were not strictly cases of Osteo-Aneurism."

Dr. Carnochan is evidently aiming to acquire a just and lasting fame by his
surgical operations, and we bid him God speed in his laudable efforts. He is
now one of the most prominent Surgeons of the great metropolis.

We thank Dr. C. for his favors.

Review. — Dr Ffrgusson on Practical Surgery. 825

VIII. — A System of Practical Surgery. By Wm. Fergusson, F.
R. S., Professor of Surgery in King's College, Surgeon to King's
College Hospital, etc. Fourth American from the third London edi-
tion. With 393 Illustrations. Philadelphia, Blanchard and Lea.
1853.

This excellent practical work has been for some time in the hands of the
profession, having already reached in London the third, and in America, the
fourth edition; indubitable evidence of the great merits of Mr. Fergusson's
" System."

Of this edition the author says, " Considerable additions have been made to
it ; but there will yet appear much wanting towards perfection, especially in
the estimation of those who look for something pertaining to all Surgery under
the title of ' System.' "

This then is a sufficient guarantee that this edition will meet the wants and
fulfil the expectations of the American medical student and practitioner. • The
plates, of which there are a great number, are well executed, and give addi-
tional value to the work.

White, 105 Canal street, has a number of copies for sale.

IP art lonxtt).

MISCELLANEOUS MEDICAL INTELLIGENCE,

I. — PROCEEDINGS OF THE LOUISIANA STATE MEDICAL SO-

CIETY,

At its Fourth Annual Session, held in the city of New Orleans, March, 1853.

New Orleans, March 14, 1853.

Pursuant to public notice, the Louisiana State Medical Society was this
day convened at 12 o'clock, M., in the Hall of the Medical Department of the
University of Louisiana, to hold its annual session.

The President, Dr. J. M. W. Picton, having taken the chair, the Society
was called to order, the roll of members read, and the business of the Society
commenced.

The following members answered to their names, viz :

The President, Dr. Picton, and Doctors Barton, Bein, Browning, Ball, Ben-
edick, Baldwin, Mr. Bolton, Doctors Copes, Bennett Dowler, Fenner, Farrell,
Hale, Henderson, McKelvey, C. W. Porter, Rouanet, Randolph, Simonds, and
Howard Smith.

The Corresponding Secretary was now called upon by the President to re-
port to the Society respecting the projet which was ordered to be printed,
at a special meeting of the Society ; whereupon Dr. Simonds stated that the
prqjet had not been printed according to resolution, the chief reason being an
empty treasury.

The names of the following candidates for membership were read over, and
upon motion taken up seriatim and unanimously elected, viz :
F. B. Page, M. D., Donaldsonville.

J. Sabin Martin, M. D., New Orleans. B. Laplace. %
J. L. Crawcour, M. D., New Orleans.

Miscellaneous Medical Intelligence.

827

J. W. B. McGimsey, M. D., Baton Rouge*

J. Dominique, M. D., Ascension Parish-

Geo. C. Colmar, M. D., Springfield, Livingston Parish.

Samuel D. Campbell, M. D., New Orleans.

Sigismond Kisfiy, M. D., New Orleans.

Adolphus Bruenn, Apothecary, New Orleans,

A. Broussard, Apothecary, New Orleans.

JohnS. Sandford, M. D.. Alexandria, La.

D. Elliot, M. D., New Orleans.

< Albuzzi, M. D., New Orleans.

D. Macgibbon, M. D., New Orleans.
R. M. Graham, 3VLD., New Orleans.

Dr. Bein then moved that the annual address of the President be read to*
morrow instead of this day (Monday) and that the Secretary give notice of
such postponement in the Picayune aud Delta, and the French side of the Cou-
rier, and invite the attendance of Physicians and the public generally,

Dr- Copes moved a suspension of the rules, and the question upon the post*
ponement of the President's address was then put to the Society and carried.

The Secretary then read the annual Report of the Board of Administrators,
which, upon motion, was received and adopted.

On motion, the resolution of Dr. Barton, on page 3 of the printed proceed-
ings, was called up ; whereupon Dr. Henderson moved "that the resolution of
Dr. Barton be amended, so that it shall read thus: That no member be eligi*
ble to any office of this Society unless he bean attendant at the session."

The above resolution having been seconded, was put to the Society and
carried.

The President suggested a revision of the Constitution and By-Laws during
the present session ; whereupon Dr. Simonds offered the following resolution

Resolved, That the pending resolution of Dr. Barton, with the Constitution
and By-Laws, be referred to a special committee of three members, to repor^
during the present session of the Society. Carried.

The President appointed on said committee the following members, viz., Drs.
Simonds, Barton and Fenner.

There toeing no further business before the Society, on motion, it was ad-
journed to Tuesday, the 15th inst., at the same hour and place.

G. T. Browning, M. D-,

Recording Secretary.

828

The New-Orleans Medical and Surgical Journal.

New Orleans, March 15, 1853.

The Society met pursuant to adjournment this day, at twelve o'clock, M., the Pre*
sident, Dr. Picton, in the chair.

The Secretary called the roll of officers and members, the following answering to
their names, viz :

Doctors Axson, Bein, Barton, Browning, Ball, Benedick, Baldwin, Mr. Bol-
ton, Doctors Copes, Dowler, Edwards, Fenner, Farrell, Foster, Hunt, Halej
Henderson, Hester, McRelvey, Moss, Nutt, Meux, Nott, Picton, Riddell, Roua-
net, Randolph, Simonds, Smith, Stone, Tompkins, Ulhorn, Wedderburn, Domi-
nique, Crawcour, Colmer, Kisffy, Reynolds, Albuzzi, Macgtbbon, Graham, and
Mr. Bruenn.

The minutes were then read and approved, the omission of two or three names of
members newly elected having been corrected.

Dr. Bein, Vice President, having been called to the chair, the President, Dr. Picton,
read his annual address, which was elaborate and interesting, At the conclusion of
this Dr. Riddell offered the following resolutions :

Resolved, That the thanks of the Louisiana State Medical Society be tendered to
their President, Dr. J. M. W. Picton, for his eloquent and able address, to which the
members present have listened with pleasure.

Resolved, That a copy of the address be requested for publication with the minutes
and proceedings.

Carried.

The election of officers for the ensuing year was next declared in order, and aftej?
going through the prescribed form for said election, the following named gentlemen
Were duly chosen to the respective offices :

E. D. Fenner, M. D., New Orleans, President.

Joseph Rouanet, M. D., " "}

A. Hester, M. D., " | Vice

J. W. P. McGimsey, M. D., Baton Rouge, J- Pres's*

J. Dominique, M. D., Ascension Parish, j

Thos. Cottman, M. D., " J

N. B. Benedick, M. D., Corresponding Sec'y.

D. Macgibbon, M. D., Recording Sec'y.

E. C. Bolton, Esq., Treasurer.

The newly elected President, Dr. Fenner, upon taking the chair, returried appro-
priate acknowledgments to the Society for the distinguished mark of approbation
Which it had conferred upon him, and assured the gentlemen present that it should be
his endeavor zealously to discharge the duties imposed upon him.

A note from Thomas*Hunt, M. D., Dean of the Faculty, was received and read
to the Society, inviting the President and members of the Louisiana State Medical
Society to attend the ceremony of conferring degrees upon the graduates of the Mc
dical Department of the University on Thursday, 17th inst., at twelve o'clock.

On motion, the invitation was accepted by the Society.

Miscellaneous Medical Intelligence.

829

The following gentlemen were duly elected members of the Soeiety, viz ;

Dr. William Carson, New Orleans.

Dr. William Malcomson, New Orleans.

Dr. J. C. Harvey, New Orleans.

Dr. A. Faget, New Orleans.

Dr. Francis Barnes, Tensas Parish.

Dr. V. Kauffman, Pointe Coupee.

Dr. George E. French, Alexandria.

Dr. J. W. P. McGimsey, Baton Rouge.

On motion, the Society then adjourned, to meet at the same place at seven o'clock,
P. M.

G. T. Browning, M. D., Rec. Sec'y.

New Orleans, March 15, 1853.

The Society met this evening in the Medical College, according to adjournment,
at seven o'clock, Dr. Fenner, President, in the chair.

The minutes of the previous meeting were read, and after some slight alterations
were approved.

The reading of the roll of members was on motion dispensed with.

The Treasurer read to the meeting his annual report. The same was on motion
received and ordered to be filed.

The President appointed Doctors Hale, Smith and Tompkins a committee to exa-
mine the Tleasurer's books and accounts, and to report thereon to the Society.

Dr. Farrell movea that the Society place at the disposal of the Dean of Faculty of
the Medical College the spare copies of the printed proceedings of last year ; which
being seconded, was put and carried.

The President then called up the different standing committees in their order, to
present their respective reports.

Dr. Josiah Hale, chairman of the committee on Botany and Natural History, pre-
sented his report on the Pepperworts, [Marsileaceae] the Mosses, [Musci] and the
Lichens [Lichenes] of Louisiana, and on the Fresh Water and Land Shells of the
State, accompanying the same with a few explanatory remarks. The report was
on motion received* and ordered to be retained among the archives of the Society.

The Recording Secretary was instructed to notify the chairmen of the standing
committees (excepting the chairman on therapeutics and the chairman on diseases
peculiar to negroes, both of whom had already signified that they had declined)
that the Society was in session and desired their respective reports.

The projet to incorporate the Society and regulate the licensing of physicians in the
state, which had been before a previous meeting, was then called up and read ; and
after some considerable discussion, the following resolution, offered by Dr. Copes and
seconded by Dr. H. Smith, was put to the meeting and carried.

Resolved, That a committee of five be appointed, to whom shall be referred the
whole subject of the projet of incorporation, license law, etc., as they concern the
welfare of this Society, with instructions to report thereon at the earliest practicable
moment , such report to be always in order.

The President appointed on that committee Doctors Copes, Picton, Hale, Smith
and McGimsey.

107

830 The New-Orleans Medical and Surgical Journal.

The Society then on motion adjourned till the following day at 12 o'clock, to
meet in the same place.

D. Macgibbon, M. D.,Rec. Sec'y.

New Orleans, March 16, 1853.

The Society met this day at noon, in the Medical College, the President in
the chair. The minutes of the previous meeting were read and approved. On
motion, reading the roll of members was dispensed with.

The Board of Administrators reported favorably of the following applicants
for membership in the Society, viz :

Doctors Lucien Hensley, Robert Hagan, Romaine Schlater, New Orleans.

Dr. James Gilpin, Shreveport.

Dr. S. C. Guy, East Baton Rouge.

Dr. George H. Walker, Washington.

The above gentlemen were then individually voted on, and declared to be
duly elected members of the Society.

The Board further reported, that the application of Dr. Goodall, which was
before them, lies over for consideration.

Dr. N. B Benedick, chairman of the committee on Midwifery, etc., according
to previous arrangement, then read to the Society the report of said committee;
after which it was on motion, received and ordered to be referred to the Board
of Administrators.

Dr. Copes moved that Dr. Cartwright be invited to present to the Society a
paper which he had prepared " On the influence of Climate, etc., on the Vege-
table Kingdom," which was agreed to ; and it was further agreed that the
reading of said paper would be in order so soon as the reports of standing
committees were presented.

The report " On Adulteration of Medicines," etc., was, on motion, made the
order of the day at next meeting.

It was then, on motion, agreed to adjourn till 7 o'clock in the evening, to
meet in the same place.

D. Macgibbon, M. D., Rec. Sec'y.

Evening Session.

The Society met this evening in the Medical College, the President in the
chair. The minutes of the previous meeting were read and approved.

Dr. Browning, chairman of the committee " On Adulteration of Medicines,"
etc., read the report of said committee to the Society ; after which, on motion
of Dr. Picton, the report was received and referred to the Board of Adminis-
trators.

Dr. Cartwright read before the Society the paper above referred to ;* when
it was moved and agreed to that said paper be requested from its author to be
placed at the disposal of the Board of Administrators.

* This paper will appear in our July No. Ed.

Miscellaneous Medical Intelligence.

831

Dr. Copes, chairman of the special committee to which was referred the
subject of incorporating the Society, etc., then presented the following report
and resolutions, which were on motion received.

The special committee to whom was referred the projet of a statutory law
embracing incorporation for this Society, and a plan for licensing practitioners
of Medicine and Surgery in Louisiana, together with all matters relating
thereto, beg leave respectfully to report.

In their opinion, incorporation is both desirable and easy of attainment
They see no necessity for an application to the Legislature, since by the Gen-
eral Law of Incorporation, enacted 30th April, 1847, the steps to obtain such
incorporation for literary, scientific, charitable and religious bodies, are plain
and certain, while the privileges are ample, and the attendant expense very
small.

Your committee therefore recommend, that measures be taken to secure in-
corporation under the provisions of the above mentioned law.

They also recommend, that no attempt be made by this Society to procure
any State legislation on the subject of license, satisfied as they are, that even
if a wise and righteous law of this kind could be passed, it would at best re-
main a dead letter, and in the view of too many, be regarded as a reproach to
regular medicine. As the best means to uphold the dignity, defend the rights,
and promote the usefulness of the medical profession in Louisiana, your com-
mittee would recommend the employment of all proper measures to increase
the membership of this Societv, extending if possible into all parts of the State,
but at the same time observing rigidly the rules now in use for the admission
of members ; and the granting certificates of membership to all who obtain
this right.

All of which is respectfully submitted.

J. S. COPES,
J. W. P. McGIMSEY,
JOSIAH HALE,
J. M. W. PICTON,
H. SMITH.

Your committee therefore submit the following resolutions :

1. Resolved, That the Board of Administrators take such steps as may be
deemed requisite to obtain incorporation under the provisions of the general act
of incorporation for literary, scientific, charitable and religious bodies and as-
sociations, enacted 30th April, 1847, taking so much of the projet reported as
relates direetly to incorporation.

2d. Resolved, That the transactions of this annual meeting be published
and distributed by the Administrators, so far as may be in their power, to every
practitioner of good standing in the State.

3d. Resolved, That the Board of Administrators have prepared a suitable
plate for certificates of membership in this Society, and that they issue such
certificates, properly filled up and duly attested by the officers of the Society,

832 The New -Orleans Medical and Surgical Journal.

to the members thereof, upon payment of such an^amount as will cover the pro
rata expense attending it.

Dr. Browning moved, and it was carried, that the consideration of the fore
going report and resolutions be deferred till next meeting of the Society, when
they be made the order of the day.

It was agreed that the annual assessment on the members of the Society
shall be five dollars for the current year.

It was then, on motion, agreed to adjourn till the following evening, at 7
o'clock, to meet in the same place.

D. Macgibbon, M. D.,jRec. Seo'y.

New Orleans, March 17, 1853.

The Society met this evening in the Medical College, the President in the
chair. The minutes of the previous meeting were read and approved.

The application of Samuel Hyatt, Esq., licentiate of the Apothecaries Com-
pany, London, which was before the Board of Administrators and reported on
favorably, was presented to the Society, when some discussion ensued as to
the nature of the powers possessed by the above Company, and the title of those
possessing a license from the same to admission in this Society as medical
practitioners ; and it was ultimately moved by Dr. H. Smith, and seconded by
Dr. Axson, that the whole matter be laid on the table, which was carried.

Dr. Simonds requested leave to withdraw from the committee on the revision
of the constitution and by-laws, which was not granted.

Dr. Fenner also made the same request, which was granted, and the name
of Dr. Picton substituted.

The report of the committee on the license law, etc., presented at the previ-
ous meeting, was then called up and read to the meeting.

Dr. Picton moved to strike out in the third resolution all after " thereof,"
(referring to members paying for certificate of membership) which was agreed
to ; when the report and resolutions as thus amended were put to the meeting
and carried.

Dr. Picton as chairman of the committee on the revision of the constitution
and by-laws, presented a copy of the same as revised, which was read over to
the meeting ; when, on motion of Dr. Browning, the consideration of the con.
stitution and by-laws was postponed till the next meeting, to be then made the
order of the day ; and the Recording Secretary was instructed to insert in two
of the city papers a notice of the same, that the members might be duly apprised
thereof.

It was then agreed to meet in the same place on the following day, at 12
o'clock, noon, till which time the society on motion adjourned.

D. Macgibbon, M. D., Rec. Sec'y.

Miscellaneous Medical Intelligence.

833

New Orleans, March 18, 1853.

The Society met this day at noon, in the Medical Gollege, the President in
the chair. The rough minutes of the previous meeting were read over to the
meeting and approved.

The application of Dr. A. C. Robertson, and of Dr. Philip Yeizer, of New
Orleans, for membership, which had been before the Board of Administrators,
and reported on favorably, were acted on by the meeting, and both of the ap-
plicants declared duly elected members of the Society.

The revised Constitution and By-Laws then came up for action. The Consti-
tution as read was submitted to the sense of the Society and declared to be
unanimously adopted.

The By-Laws were next submitted in the same way, and after some slight
alteration, were declared to be adopted by the Society. Both, according to the
requirements of article eight of the Constitution, lie over for the action of the
Society at its next annual session.

The special committee on the Treasurer's accounts, etc., presented the follow-
ing report, which was on motion adopted :

The committee of the Louisiana State Medical Society appointed to ex-
amine the accounts of the late Treasurer, Mr. E. C. Bolton, beg leave to report,
that they have examined these accounts and find them correct. Signed,

T. O. TOMPKINS,
HOWARD SMITH.

New Orleans, March 18, 1853.

The following resolution, offered by Dr. Crawcour, was then put and
carried :

Resolved, That the memorial presented to the State Legislature last year,
for the object and purpose of obtaining a law for the Registration of Births,
Deaths and Marriages, be again presented and urged at the present session of
our State Legislature by the Board of Administrators of the State Medical
Society.

It was on motion agreed, that the Board of Administrators be empowered to
strike from the roll of membership the name of any member who may, either
personally or in writing, express a wish to withdraw from the Society.
The following resolution, offered by Dr. Picton, was adopted :
Resolved, That the Board of Administrators be directed to publish in the
pamphlet containing the proceedings of this annual meeting a list of the offi-
cers and members, and as far as practicable, their places of residence or ad-
dress.

Mr. E. C. Bolton offered the following resolution, which was adopted :
Resolved, That the thanks of this Society be tendered to the faculty of the
Medical College of the University of Louisiana, for their renewed courtesy and
cordiality in granting this Society the use of their- Hall for the present annual
session.

The following resolution, offered by Dr. Picton, was adopted :

834 The New-Orleans Medical and Surgical Journal.

Resolved, That the Corresponding Secretary be instructed to address by-
letter members of this Society from the country parishes, and urge upon them
the necessity of speedy action in forming Country or District Medical Associa-
tions or Societies, auxiliary to the Louisiana State Medical Society, to be gov-
erned by a constitution and by-laws, to qe submitted to this body in annuaj
meeting for approval.

Dr. Benedick offered the following resolution, which was carried :
Resolved, That the Board of Administrators appoint, and the President
commission, the proper number of delegates to represent this Society at the
next annual meeting of the " American Medical Association," to be held in
the city of New York on the 3d day of May ensuing ; and that so many of them
as may be able to attend said meeting shall be required to present at the
next annual meeting of this Society a written report of their mission.
Dr. Browning offered the following resolution, which was adopted :
Resolved, That the Board of Administrators be authorized to pay to the
Janitor of the Medical College such compensation for his services, rendered
during the present session of this Society, as they may deem just.

After tendering a vote of thanks to the officers of the last year, and agreeing
to hold the next annual session in this city, the Society on motion adjourned.
(Signed)

E. D. FENNER, M. D., President.
D. Macgibbon, M. D., Recording Secretary.

The President appoints the following Gentlemen Chairmen of the standing
Committees and it is hoped they will faithfully discharge the duties assigned
them :

1. On Medical Education, Dr. A. W.Ely.

2. On Anatomy, Surgery and Surgical Anatomy, Dr. Crawcour.

3. On Physiology and Pathology, Dr. A. F. Axson.

4. On Midwifery and Diseases of Woman and Children, Dr. Benedick.

5. On Practical Medicine, Dr. McKelvey.

6. On General Therapeutics, Materia Medica and Pharmacy, Dr. Copes.

7. On Meteorology and Hygiene of the State and its Vital Statistics, Dr.

Barton,

8. On Diseases Peculiar to Negroes and to a Southern Climate, Dr.McGim-
sey.

9. On Adulteration of Medicines and the sale of Drugs and Nostrums,

Mr. E. C. Bolton.

10. On the Medical Botany of the State, Dr. J. Hale.

Miscellaneous Medical Intelligence.

II. — Collodion in the treatment of Buboes.

The March number- for 1843 of the Stethoscope, contains some practical ob-
servations by Dr. Herbert Claiborne, of Petersburg1, on the value of collodion
in the treatment of buboes. He says :

'* I use the cullodion solely for the purpose of discussing or scattering the bubo, and
in my hand it has proved incomparably superior to any other discutient. It operates
by pressure, I believe, and thereby lessening the capillary congestion of the parts,
and stimulating the absorbents to remove whatever products may have been thrown
out by inflammation about or in the affected glands,

I have used it in the treatment of buboes of the groin only. When a patient with
a bubo presents himself, if there be not much acute local iuflammation, no matter how
formed, and no constitutional reaction, I immediately shave off the capilli from and
around the tumor, and with a camel's hair pencil apply the collodion upon the place
allowing one layer to dry before the application of another, until I form a scab or
membrane of such thickness as I think will exert the proper compression. Some-
times the application has to be renewed in the course of twenty-four or forty-eight
hours. If put on too thickly it will give a great deal of pain ; and I have seen it con-
tract so tightly upon the tumor, that the epidermis would be split in fissures around
the borders of the application. This will serve to give some idea of the force of the
compression which it will exert. After the application of the collodion, it is better
that the patient remain quiet for a day or two, take an aperient, and restrict his diet?
though I have succeeded in discussing a chronic bubo when not an hour has been
lost from his usual avocations.

If there be much inflammation about the tumnr, I usually endeavor to subdue this
by general and local depletion, saturnine applications, etc., before applying the col-
lodion ; and if the bubo be of venereal origin, I institute of course the specific treat-
ment for the existing disease."

We have succeeded in discussing indolent stationary buboes, after all other
means had failed, by the application of an ordinary truss, perfectly adapted to
the enlarged gland. The largest buboes, if not too tender, may be made to
yield to mechanical pressure, constantly kept up for six or eight days. We
have never used the collodion for the particular affection above indicated ; but
we have applied it to other indolent swellings and inflamed points with good re-
sults. We have no doubt of its superior efficacy in the discussion and resolu-
tion of chronic buboes. Let the profession give it a trial.

(Ed. N. O. Med. and Surg. Jour.)

830 The New-Orleans Medical and Surgical Journal.

III.— A four-pronged fork swallowed, and subsequently extracted from the thigh.
[Translated and abridged from the Rev. de Therap. Med. Chir., Fevrier 1853,]

(By Ed. N. O. Med. and Sur. Jour.)
Good,in his "Study of Medicine," makes mention of individuals who, prompted
by a depraved, a morbid appetite, swallowed old nails, knives, files, etc., which
were found after death in the stomachs of those subjects ; yet the present case,
taken from a late French journal, and fully authenticated, deserves to be recorded
as both unique and singular in all its details. We regret that our space restricts
us to a mere abstract of this interesting history.

To begin, then. The subject was a female called Catharine, aet. 57, the
wife .of a retired officer, dwelling in the commune of Haute Saone, of a ro-
bust constitution, of a nervo-bilious temperament ; the mother of two healthy
children.

At the age of about 35 years her menses ceased, when she manifested strong
symptoms of suicidal monomania. She made several ineffectual efforts to de-
stroy herself; but in this she was defeated. Finally, she attempted to swal-
low an iron fork ; but this was extracted by the family physician, M. Le Tel-
Her, who reports the case, aftor some considerable effort. Several years sub-
sequent to this strange freak, Madame C. again attempted to thrust a fork down
the throat ; but the physician being called, again succeeded in extracting it,
to the great satisfaction of the patient. Eight months after this experiment,
without any pains in the stomach and bowels, without any derangement of the
digestive functions, Madame C began to complain of intense pain in the left
hip and thigh-— pains which destroyed her rest and made it difficult to walk.
Her medical attendant, seeing nothing externally, deemed hers a case of sci-
atic neuralgia. For four years Dr. Le Tellier heard nothing of his patient,
when he was again summoned to her assistance. This was in 1852. He
found the pains in the thigh intense ; for two years she had remained in bed,
unable to movejierself ; her pulse was small and feeble, scarcely perceptible ;
no appetite; extreme emaciation ; little sleep ; lower limbs infiltrated; colli-
quative discharges; with nocturnal fevers. On the superior and external part
of the left thigh, considerable tumefaction existed, painful on pressure, parti-
cularly near the trochanter. Here the integuments were somewhat discolored.
Emollient cataplasms were ordered to the painful spot, and Peruvian bark given
internally to support the strength.

Madame C, who had now fully recovered her intellectual faculties, informed
her medical attendant that all medication was useless ; for, said she, " it is a
fork in my thigh, and I shall continue to suffer until it is removed." The poul-
tices were continued for one month, when the painful spot spontaneously
opened, about four fingers beneath the trochanter major, and discharged a
quantity of pus.

By probing and manipulations, her medical attendant discovered an iron fork,
and with a pair of forceps, extracted it at once. This then settled the ques-
tion, and put all doubt to rest ; Madame C. had actually swallowed a fork. She

Miscellaneous Medical Intelligence*

837

then detailed all the particulars; that on the second day after the 2d fork had been
removed from her throat, she succeeded in swallowing the one which had just
been removed from her thigh ; that it had four prongs ; that it caused no pain
nor uneasiness either in her stomach or bowels.

A sketch is here given of the fork before it entered the stomach, and also of
as much of it as remained after its extraction. The handle, as well as one of
the prongs was nearly destroyed by oxidation ; but in other respects it was
well preserved. She continued to sink, and on the eighth day after the extrac-
tion of the fork, Mrs. C. perished.

A thorough autopsy, so much desired, was refused ; the parts however, from
which the fork was taken, were laid open, and a number of purulent abscesses,
mostly empty, were revealed around and below the trochanter major. Mr. Le
Tellier, to whom, as already related, we are indebted for the facts of the forego-
ing case, makes the following reflections on this extraordinary case.

In the first place, says he, is it not extraordinary that a foreign body, of the
nature of the one under notice, should sojourn for nine months in the digestive
organs, without determining serious accidents, and without any disturbance of
the economy, until by an admirable effort of nature, it makes its way down to
the thigh, where it begins to excite pain, which persists for three years, How
long, it may be asked, did the fork remain in the stomach? Was it during its
sojourn in this organ, under the solvent action of the gastric juice, that a portion
of it was broken down? After it escaped through the pylorus, is it probable
that it perforated the small intestine at some one point, or did it traverse the
entire alimentary tract, leap over the ilio-scecal valve, and pierce the descend -
ing colon ? Once out of the intestine, what course could it have taken to have
lodged behind and near the trochanter major ? What became of the handle of
the instrument ? Did it remain in the system ; or rather, may we not sup-
pose that by oxidation it was so reduced in size as to make its escape per
anum ?

Many of these questions might have been definitively settled, had it been
possible to make a searching post-mortem examination. Altogether, the case
is without a parallel in modern surgery.

To our excellent friend, Dr. C. Delery of this city, we r^re indebted for the
journal, from which we obtained the particulars of the above case.

IV. — Treatment of Pneumonia by inhalation of Chloroform.
Some of the most distinguished practitioners of Europe, of whom Dr. R. B.
Todd is one, begin to cast some doubts upon the depletive plan of treating
pneumonia in its incoative stages. They argue that the lancet, cups, and even
tartar emetic, may generally be dispened with in a great number of cases —
for all of which Dr. Todd substitutes stupes of warm turpentine to the chest,
and the internal administration of the acetate or citrate of ammonia, with an
occasional mild purge.

108

838

The New-Orleans Medical and Surgical Journal,

Vearrentrapp of Frankfort has written on this subject, and recommends the
inhalation of Chloroform in the treatment of pneumonia. He gave it in quan-
tities too small to produce insensibility ; and the effect in every case was a
free perspiration, and a great reduction in the frequency of the pulse. He is
hence highly pleased with this plan of treatment.

Does Chloroform in such cases cure the pneumonia, by acting directly on
the blood, passing through the lungs ?

[ Condensed from Braithwait — Ed. N. O. Med. Jour.]

V. — Cauterization in Croup.

A violent case of croup, reported by Dr. English in the Philadelphia Medical
and Surgical Journal for March, 1853, was relieved, after the usual active mea-
sures had failed, by the direct application of a strong solution of the nitrate of
silver (60 grains to the ounce) to the larynx. The application, says Dr. E.,
which was deep and thorough, and made while the little patient was crying —
was followed by a copious expectoration of mucus, mixed with the false mem-
brane, of which an enormous amount was discharged. On the second day,
two applications were made ; and on the third, but one ; after which the boy
rapidly recovered.

(Ed. N. O. Med. Journal)

VI. — Treatment of Acute Rheumatism.

BY DR. MAXSON.

As acute rheumatism is a disease, the pathology of which has been a matter
of doubt, and the treatment consequently various, I here offer a plan of treat-
ment which I have found very satisfactory.

In a severe case, in which the inflammatory fever runs high, if the arms are
suffering, I draw froi^ two to four ounces of blood, by cups, from each side of
the spine, near the origin of the brachial nerves, between the shoulders. If the
lower limbs are suffering, I draw the same quantity, by cups, from each side of
the spine, in the lumbar region, near the origin of the crural nerves. This
generally relieves the pain in the limbs immediately, and checks the progress of
the disease. I procure an evacuation of the bowels by mag. sulph % ss, re-
peated, if necessary, and then give potassa nit. 9i, dissolved in a teacup full
of warm gruel, every three hours, and continue this till the fever and inflam-
matory symptoms subside, which will generally occur in from four to six days.

At this stage there is generally left slight swelling and some stiffness of the
joints. I then discontinue the nitrate and give potassa iodide, gr. x, with vin.
colch. gtt. xx, every six hours. Continue this till the slight swelling and stiff-
ness of the joints subside, which may take place in from four to six days ; the
appetite will, in the meantime, generally become good ; the patient then need
only be directed to take potassa iodide, grs. v, three times per day, for a few
days more, to prevent a relapse and render the cure permanent.

{Buffalo Monthly Medical Journal.)

Miscellaneous Medical Intelligence. 839

VII. — Danger of Guita Percha Catheters.

BY TV. W. MORGAN.

Mr. Morgan, writing from Newport, Monmouthshire, (England) to the edi
tor of the London Lancet, says :

Singular enough, on the day I received your last number, a patient came to
my surgery, having the broken end of a gutta-percha catheter remaining in the
urethra. I enclose you the distal end for ocular proof. The catheter broke
while my patient was either in the act of getting out of bed, with the object of
drawing off the urine into the chamber utensil, or stooping to raise it up — he
cannot tell which ; but he felt considerable dismay on bringing out only about
one half of the instrument, the other half remaining firmly grasped by the
stricture. He had used it for the last year and a half, and never discovered
the slightest crack, nor want of flexibility in its structure.

Another writer (F. Negus, R. N.) writing to the same periodical on this sub-
ject, says :

I enclose some fragments of a gutta-percha catheter, which has la in for about
three years, unused, in my instrument case, during a sojourn on the coast of
Africa. The instruments have been preserved quite bright, without the use of
any oily preparation ; but some molecular change has taken place in the ca-
theter, so that it has become extremely brittle, and, on my attempting to with-
draw thestilet, has instantly split across in a dozen places. I need not dwell
upon the fearful consequences which must ensue, if an instrument such as this
had been passed into the bladder for the purpose of drawing off its se-
cretion.

I am not aware if such a change as I have j ust described has been noticed
in gutta-percha ; if it has not, you will oblige me by noticing the fact in your
journal.

In reference to the foregoing, the editor remarks — " The portion of catheter
forwarded to us is remarkably brittle."

VIII. — Spasm of the jEsophagus cured by Strychnine.

Spasm of the oesophagus is frequently associated with hysteria or hypochon-
dria, and is often so obstinate as to interfere seriously with alimentation. This
grave affection has been completely relieved by the administration of strych-
nine, in doses of one and two centigrammes. M. Mathieu relieved by this me-
dicine a female who^had suffered for six months with spasms of the oesophagus;
they were so severe as to cause the instant and violent rejection of all solid
food, the moment any attempt was made to swallow. The strychnine was not
given until all other antispasmodics had failed and been abandoned.

(Revue Ther. Med. Chir. 1853.

840 The New-Orleans Medical and Surgical Journal.

IX. — Iodide of Sodium as a remedy for Constitutional Syphilis.

In one hundred and fourteen subjects affected with syphilis, in its various
Btages, Dr. P. Gamberini, of the Bologna Hospital, tested the iodide of sodium,
and found it preferable to the iodide of potassium in this form of syphilis. The
former was less likely to disturb the stomach, did not produce any eruption, and
had no bad effects upon the mouth. M. G. asserts that he has seen many cases
of secondary syphilis stationary under the prolonged use of the iodide of po-
tassium, promptly give way to the iodide of sodium. M. Gamberini thus con-
cludes :

1st. Soda having a strong affinity for our organism,where this calculi abounds,
should, a priori, be considered as more readily assimilated than potash.

2d. The iodide of sodium is less disagreeable to the taste, and therefore
more readily taken by patients.

3d. The iodide of sodium has succeeded in cases where the iodide of potas"
Bium has failed.

The patient may begin with about one scruple daily, in three ounces of dis-
tilled water, increasing the dose six grains daily, until 2 gros, or 8 grammes,
are taken.

4th. The iodide of sodium is a better substitute for mercury.

[Journal des Connais. Medico- Chirurg. ■

X—Dr. Paul J. Eve.

We read with gratification your attempt, in a late number of your Journal,
to perpetuate the names of our talented medical men while living. The en-
terprise, if pursued, must place your Journal upon a high round in the scroll of
fame, and command for yourself the gratitude of your brethren in perpetuity ;
for the memories of our able men in the profession, to our disgrace be it told,
is a blank page in American medicine. The divine, statesman, chieftain, mer-
chant, poet, sculptor and painter, have their talents and virtues recorded in life
by their admiring sects; but he who stands by the dying couch of them all,
and administers to their wants under the mosttrying and abused circumstances
— the physician — is permitted to drag along through life, best as he can, amid
toil and poverty, however brilliant his talents, unknown and unsung.

This is a piece of ungrateful injustice, at which our heart sickens and our
feelings revolt. The medical profession is as talented, worthy and reputable
as any class of men in America ; among them are some of the brightest lumin-
aries which adorn this nation ; yet they will never be known, because their
brethren have not magnanimity enough to record their merits. All this is
wrong ; men professing to secure respect must regard themselves ; and if the
medical profession wishes to take its stand in society, it must place its rising
and talented men prominently before the country, and demand for them the first
rank; we have just entered into the brotherhood; the "honey moon" of our
diplomate has not passed, but we have begun with a resolve to elevate our
profession and tell the virtues of our Southern fathers in medicine ; we have
begun with the gentleman whose name heads this article, and we shall continue
the subject with others at our leisure, feeling assured we could not offer a better
boon to Northern men.

Miscellaneous Medical Intelligence. 841

The first man on our list is Doctor Paul F. Eve. Doctor Eve is a Georgian,
and descended from a most reputable ancestry ; he is a stout, hale and fine
looking man in physical appearance ; he is a perfect gentleman, warm in his
attachments and sincere in his feelings; from his want of modern duplicity,
the pedantic and presumptuous never like him privately, but he is a favorite
with the high-toned, manly and honorable. Doctor Eve graduated, we think,
in the University of Pennsylvania, thence he went to Europe and became
involved in the Polish revolution ; there he saw much surgery, and is evidently
one of the best military surgeons in America ; so well convinced were his
friends of that fact, that the late President Polk tendered him a surgeon's com-
mission while our army was marching upon Mexico. Doctor Eve held for
many years the chair of surgery in the Medical College of Georgia. In con-
sequence of family afflictions he resigned, and subsequently accepted the same
chair in Louisville, Kentucky ; the same reasons caused his resignation, but
after a long expected and painful event, the demise of his wife, he was induced
to accept the surgical chair at Nashville, Tennessee, where his name and
influence have crowned that school with remarkable success, and will make it
a focal point for the South and West in medical education.

As a surgeon, Doctor Eve has no superior ; he is, and deservedly too, the
head and front of Southern surgery, and has a better surgical practice than any
man in the South. As an operator, he is bold, safe and dexterous. As a
teacher of surgery, he has few equals ; he is plain, practical and concise in his
lectures, using no ostentation, but placing his subject, in a clear and distinct
tone of voice, clearly before his class ; he deals in no idle specialities in
delineating his subject, but confines himself to facts and truths, instead of vague
antithesis and conjectural conclusions.

As a surgical writer he is clear and pointed, and it is to be hoped he will
furnish his Southern brethren a complete work upon Southern Surgery, the
result of his long and honored experience.

The name of Doctor Eve may be almost linked with the Nestorship of South-
ern surgery ; he has done more for the science South than any man in the
profession, and like other men, he has had a tortuous race to run ; it is curious
that our ablest men have the bitterest enemies ; it is said that the celebrated
Brodie is the most hated of any man in London, and no one doubts his surgical
prowess; we believe to be a talented man in medicine, is to secure enemies;
there is no use in hating and misrepresenting an ordinary man ; it brings no
credit upen the slanderer ; we wish it were otherwise, but it is an actual fact
that medical men have more bickerings than all others. These remarks are
general, and apply to no particular case, for Doctor Eve, like all other great
men, has outlived all his assailants, and can bid any man defiance, for his
reputation and fame place him beyond the reach of successful calumny.
Surgery with Professor Eve is a speciality ; he is devotedly fond of it ; he is a
loving man, a man of science, a real specimen of a real surgeon, who will
command respect anywhere.

[Philadelphia Medical and Surgical Journal.

XI — Fifty Dollar Prize for the best Essay on some Medical Subject.

We invite the special attention of the medical profession of our sister State,
Alabama, to the card below, offering a Prize of $50 for the best original Essay
on some medical subject, to be chosen by the author, and submitted to the
adjudication of the Alabama State Medical Association.

842

The New-Orleans Medical and Surgical Journal,

The amount, though handsome enough, is not designed as a just reward,
but rather intended to develop and encourage the medical talent of the State ;
and we have no doubt that he who may obtain the prize, must produce an Essay
of uncommon merit.

Medical Journals circulating in Alabama will promote the cause of science
by giving the subjoined an insertion.

(Ed. N. O. Med. Jour.)

PEIZE.

Whereas, the Prize Essayist at the last meeting of the Alabama State Med-
ical Associatian (L. H. Anderson, M. D.) has presented Fifty Dollars " to be
offered to the medical profession of Alabama for the best original practical
Essay upon some (or any) subject of medical science, to be read at our next
stated meeting," at Montgomery, 2d Monday in December, 1853: Therefore,
candidates for the prize will deliver their Essays to the first Recording Secre-
tary in Mobile, on or before the first of October next, accompanied with the
usual sealed note, containing the author's name.

A. Denny, Pres. a. s. m. a.

R. Miller, 1st Recording Sec'y.
March 27, 1852.

XII — To the Medical Profession of Alabama.
The undersigned having again received the appointment of " Reporter on
Surgery" for the Alabama State Medical Association, takes this method of
renewing the request made last year to the practitioners of the State, that they
will transmit to him, before first December next, the notes of such surgical
practice as they may have had for twelve months preceding 1st November,
1853, to be laid before the Association at its next meeting.

Members of the Association who intend to be at the meeting, can bring their
reports in person. Those who cannot be present, and physicians who are not
members, may at their option send them by some attending member, or forward
them by mail to the subscriber, before the date above named.

L. H. Anderson,

Sumpterville, Ala.

Editorial. — City Intelligence. 843

Vol. IX.] NEW-ORLEANS, MAY I, 1853. [No. 6.

HEALTH, MORTALITY, &c.

Since our last issue our city has been blessed with extraordinary health, as
will appear from the bills of mortality, which show a falling off of about 50
per cent. Indeed we have not had so small a mortality for five years past?
or at least since epidemic cholera broke out here in December, 1848. It is a
singular coincidence, that this pestilence at its last visitation should have pre-
vailed just about the same length of time as at its first, i. e., between three and
four years. Then it broke out in October, 1832, and did not disappear till the
beginning of 1836. Latterly it commenced in December, 1848, and prevailed
more or less till the present time, when it may be said to be extinct. A just
comparison of the mortality caused by the two epidemics would form an inter-
esting article, but we are not sure that the necessary statistics are accessible.
; Our late mortality from Fevers has been uncommonly small ; chiefly attribut-
able, perhaps, to the fact that very little Ship Fever has been brought in by the
emigrants from Europe. It is hoped that the dreadful mortality that for some
years past has attended these poor unfortunate wanderers from their native
land, has awakened a benevolent interest in their behalf, and caused those who
undertake the important duty of providing conveyance, to pay more attention to
the laws of hygiene. Most of the immigrants who arrived at this point during
the past winter and spring were in very good condition.

The spring has been very backward — the weather for the most part cool and
dry. So late as the 27th of March fires were found quite necessary to com-
fort. Our Meteorological Table will give a more correct account of the gen-
eral aspect of the weather. It is somewhat extraordinary that up to this mo-
ment, 16th April, but few musquitoes have been seen. We generally have
myriads of these troublesome insects by this time of the year. The relation
that this fact may bear to the state of health both now and hereafter will be
worthy of notice, as the elements that enter into their generation may be in-
timately connected with morbific causes.

Since the consolidation of the three Municipalities and Lafayette into one
city, which took place last year, a very marked impulse has been given to the
progress of improvement — a vast number of new buildings are going up, and
pavements of stone and plank are rapidly extending in all directions. These
improvements cannot fail to have a beneficial effect upon the sanatory condition
of the city, and in so far, add greatly to its general prosperity. There is still
one thing needful, and that is a plentiful supply of water for the purpose of clean-
sing the gutters. When we attain this indispensable means of preventing
disease, we may hope to see our annual bill of mortality compare more favora-

844 The New-Orleans Medical and Surgical Journal.

bly with those of other cities than it does now. If our respected Mayor and
every member of our City Councils were to read the annual Reports of the
General Board of Health of England, gotten up under the authority of law,
they would see how plainly the causes of disease are demonstrated, the best
means of removing them, and the vast number of people who die of preventible
diseases. This learned Board has recently sanctioned the bold opinion uttered
by our great countryman, Dr. Rush, who maintained that city authorities were
justly chargeable with the lives of all who die of preventible diseases within their
jurisdiction, and that they should be made responsible for the same before the
Courts of Justice. How many of our honorable councilmen have ever consid-
ered the subject in this view ! Yet there is both reason and justice in it. We,
the people, have entrusted them with the entire guardianship of the city, in-
volving our rights, property and lives ; and it matters but little to one of us
who is about to sink into an untimely grave, whether we fall by the hand of an
unlawful assassin, or a well known cause of fatal disease that might and
ought to have been removed. We trust that ere long these things will be con-
sidered in their proper light by those who are vested with authority.

The customary diseases of the season, such as scarlatina, measles, pneumo-
nia, catarrh, bowel complaints, etc., have prevailed to a moderate extent. The
usual spring rise of the river has appeared, but to a moderate extent. We
continue our weekly reports of mortality as follows :

DEATHS IN THE CITY OF NEW ORLEANS,

For the 8 ween nnding April 16th, 1853.

Cholera.

Fevers.

Total.

1853 Feb. 26th5

103

March 5th,

101

« 12th,

105

" 19th,

101

" 26th,

107

April 2d,

104

" 9th,

C. Inf. 1

117

L< 16th,

130

Total,

868

Editorial. — City Intelligence*

845

END OF THE VOLUME,

This closes volume 9th of the " New Orleans Medical and Surgical Jour-
nal," and with our next July number, we shall enter upon the tenth year and
10th volume of the Journal with a list of subscribers, of which few medical
journals on this side the Atlantic can boast. Our course from this time for-
ward, judging from the evidence before us, shall be upward and onward, if the
friends and patrons of the Journal continue, as heretoforee, to extend that "aid
and comfort" to us, so necessary to an enterprise requiring at once heavy ex-
penditures, some tact, a vast amount of patience, and ceaseless toil. With
such assurances from our friends, we can well afford to be merciful and for-
giving to our enemies, (if any we have) and just and liberal to the profession.
Our position as director and editor of the Journal, is one often of great deli-
cacy and embarrassment ; and if we fail in such an emergency to acquit our*
selves with fidelity and impartiality to particular individuals, let it be remem*
bered, in extenuation, that we seek rather to promote the honor and interest of
the profession, than to conciliate and cajole exacting cliques or unscrupulous
individuals.

In thus defining our position and foreshadowing our future course* we aim
not to provoke any unkind feelings, or bring back the recollection of wrongs,
which sprang rather from over much zeal in the cause, than a due regard for
the peace, harmony and prosperity of the profession.

With our July issue we shall enlarge our edition, that those who may order
the work during the current year, may, if expressed, receive the Journal from
the beginning of the publication year.

As the next number will begin a new volume, persons wanting the work,
should forward their names as early as practicable, that we may be prepared to
furnish them a full set of the volume. A full Index will be found at the end
of the number.

CAUTERIZING THE LARYNX AND TRACHEA.

This operation, which was first performed and recommended to the profession
eight or ten years ago, by Doctor Horace Green of New York, the practicability
of which was denied by the physicians of that city at the time, and, as we
learn, is really doubted at this day by some of the eminent surgeons of Phila-
delphia, is actually performed with much greater facility and less distress than
we could have imagined before witnessing it. A short time since we saw it
done in this city by Doctor J. H. Douglas, a pupil of Dr. Green, in the presence
of Professor Stone, Dr. Banks of Mississippi, and several other intelligent
physicians.

The patient was a gentleman who had long suffered from ulceration of the
jarynx and trachea, extending down to the bronchial bifurcation. With a
curved spatula the root of the tongue was pressed down till the epiglottis was

109

846

The New-Orleans Medical and Surgical Journal.

plainly visible. A long probang, moistened with a solution of Chryst. Nitrate
of Silver, ( B ii to the § i) was then readily passed through the rima and down
the trachea to its bifurcation. To our astonishment, the distress occasioned by
the operation was quite insignificant; not greater than we often see caused by
the same application to the posterior fauces. This patient had submitted to the
operation repeatedly and with apparent benefit.

Affections of the throat are so common in this region, that it behooves us to
learn the latest improvements in their treatment, among which that recom_
mended by Dr. Green certainly occupies the first rank. E. D. F.

MEDICAL ASSOCIATION OF THE STATE OF ALABAMA.

The proceedings of this Association at its last meeting, held in Selma,
December, 1852, have reached us too late to command the extended notice they
so richly merit. Our Southern pride is highly gratified at the substantial evi-
dences of talent and industry among our professional brethren in Alabama, as
presented in these proceedings. They make a pamphlet of 166 pages, and
are replete with most interesting original matter, which does credit both to
the profession and the State. We shall notice them more fully in our next
issue.

All honor to Alabama ! She has neither a medical college nor a medical
journal, but her students are educated at the best schools of the country, and
her physicians enrich the pages of the medical journals both North and South.
We hope soon to see an honorable emulation spring up among all the State
Medical Associations of the Union., Pdlmam ferat qui meruit !

IODIDE OF POTASH IN THORACIC DISEASE.

In looking over the journals, we observe a general feeling among some of
the first practitioners of the day, to condemn the usual mode of treating acute
diseases of the lungs and their appendages, with depletion, nauseating medi-
cines and blisters. We are not prepared to proscribe the judicious employment
of these powerful means ; although we feel satisfied that much mischief has
resulted to the public by their indiscriminate and untimely adoption. But
whatever plan of treatment may be enforced in the early — in the acute stage
of both Pneumonia and Bronchitis, we have been led, from considerable expe-
rience, in the management of these usually obstinate affections, to give the
preference to the iodide of potash, in the later stages of the disease ; when the

Editorial. — City Intelligence.

expectoration is scant, and when the secretions from the bronchial mucous
membranes are in a measure arrested, attended with slight febrile excitement,
loss of appetite, and general debility, we have derived the greatest benefit
from small and oft-repeated doses of this medicine. From its known specific
effects upon the secreting organs, and its aptitude for the nasal and bronchial
mucous membranes, we might, a priori, expect good to attend its administra-
tion in diseases of these extensive surfaces. Such has, in fact, been found to
be the case when given at the proper time, neither too early nor too late, in
Pneumonia and Bronchitis.

Under the influence of the iodide of potash, the expectoration is moderated
if too profuse, and increased to a moderate extent if too scant; hence the
pulse becomes improved, the appetite increases, which may bave been destroyed
in the early stages of the disease by the antimony and ipecac usually so freely
thrust down the throat of such patients. Try this medicine therefore, at that
stage of Bronchitis and Broncho-pneumonia when these affections have ceased
to be acute, and yet have not run into the chronic stage.

CONSUMPTION IN THE SOUTH.

It has become a popular error, both in and out of the profession, to suppose
that Consumption is developed almost exclusively in Northern latitudes — the
disease being of rare occurrence in Southern regions. Observation and a little at-
tention to facts will, we feel convinced, correct this, to some extent, fatal error.
It is conceded by all parties that sudden vicissitudes of temperature — from
extreme heat to excessive chilliness, and vice versa, often lay the foundation
for severe and fatal pulmonary diseases. Admitting this fact, we must at once
concede, that these sudden atmospheric changes are much more frequent and
sudden in the South than in the Northern parts of the United States. Nor are
the residents of the North by any means as easily affected by such changes
owing to the fact that they are much less amenable to the attacks of disease
than the relaxed and effeminate inhabitants of more Southern latitudes.

If one of the first and most obvious effects of great heat is to debilitate the
entire system; and if the maxim be true, that as we debilitate the system, we
in the same ratio predispose it to take on disease, we have at once an easy and
ready solution of the question before us.

Statistics, if carefully interrogated, will go far to place this subject in its
true light before the profession and the public ; and it becomes us of the South
to meet it at once, examine it, and publish the facts to the world.

Look at our weekly bills of mortality ! Are not nearly one fifth of these

848

The New-Orleans Medical and Surgical Journal.

put down as caused by Phthisis Pulmonalis ? Most of whom are old residents
of the city, or natives of the place.

At a future day we shall investigate this subject, and lay the result before
our readers. We now simply allude to the question.

LOUISIANA STATE MEDICAL SOCIETY.

We invite the attention of our readers to the Proceedings of the Louisiana
State Medical Society, in another part of this number. We trust this Society
will meet with the approbation and receive the encouragement of every Phy-
sician in our great and prosperous State.

This Society, now fully organized under the Presidency of our amiable and
energetic friend, Dr. E. D. Fenner, will from this day forward take a command-
ing position among similar associations of the country, and exercise a salutary
influence over the public mind.

The Address of the former President, Dr. Picton, too long to be admitted into
the Journal, will be found in the pamphlet form of the printed proceedings. It
should be read by every Physician in the State. The high reputation of the
author of this address, for learning and scientific knowledge, will impart a
moral force to the production, which must tend to elevate the ethics and dig-
nity of the profession throughout Louisiana. Dr. P., for some time connected
with the medical staff of the regular army, has been an active and successful
practitioner of medicine in New Orleans for nearly a quarter of a century ;
and he therefore speaks the words of soberness and truth, touching the inter-
est and welfare of the profession.

TRISMUS NASCENTIUM — PUS IN THE UMBILICAL VESSELS.

Some time in the month of May, 1851, a young and healthy woman was
delivered of a fine looking male child, at the full term of utero-gestation,
without any untoward accident.

On the fourth day after the birth of the child, it was seized with trismus nas-
centium and expired in 24 hours. On examination, no displacement of the
cranial bones was discovered ; but the umbilical vessels were found blocked
up with purulent fluid. All the organs, including the brain, were apparently
quite sound.

In the Edinburgh Medical and Surgical Journal, for August, 1850, Doctor
Imlach reports a similar case ; he however did not examine the cranium, nor
the spinal column. In the case published by Dr. I., the umbilical vein was
blocked up with a coagulum of blood, and the skin about the umbilicus was
gangrenous ! Was all this accidental— or was it the exciting cause of the

Editorial. — City Intelligence.

849

trismus ? Was death caused by the introduction of this purulent fluid into the
circulation ?

Since recording the foregoing notes, we have tried the effects of chloroform
in a violent case of trismus, and found it controlled the spasms, and at least
prolonged life much beyond any other remedy we have seen tried. The little
patient, but a few days old, and well developed, when first seen by us, had been
afflicted with trismus for some 36 hours, and was now evidently on the point
of expiring. We carefully administered chloroform, and watched its effects.
In a few minutes after the inhalation of the anaesthetic, the body, which had
been perfectly rigid, the jaws clenched, the face corrugated, became gradually
relaxed— the fingers flaccid, the face smooth, the countenance calm, the breath-
ing easy and natural, and the little thing slumbered. As the spasms recurred,
the chloroform was renewed, and gradually the intervals between them
lengthened, and finally ceased altogether. It was now late at night, and the
nurse, regarding the child as saved, slept at her post; and during this time the
spasms returned, the chloroform was not renewed, and at the dawn of day the
child expired.

We are inclined to believe, that had the child been diligently watched, and
the chloroform renewed, the case might have terminated differently.

PATIENT HIS OWN SURGEON— AMPUTATION OF PENIS IN A
FIT OF DELIRIUM TREMENS.

A stout German, aged about 45 years, of good general health, but of rather
intemperate habits, had, during the month of April, 1852, an attack of mania
apotu, and whilst alone in his room, and fancying that his enemies were pur-
suing him to deprive him of his genital organs, seized a sharp knife, amputa-
ted his penis close up to the pubis, and threw the organ violently at those whom
he fancied were in pursuit of him. The hemorrhage was considerable, but
no vessels were tied — the bleeding gradually ceasing spontaneously, by the
formation of a coagulum over the mouth of the divided vessels. About this
time he was brought to the hospital, wbere he made an attempt to cut his
throat. Simple dressings were ordered ; the patient gradually recovered of the
delirium, the penis healed rapidly, and we saw him on the morning of the 22d
of May, when the wound had quite healed, and he was rational and apparently
content with his extraordinary surgical feat.

This case is particularly interesting on account of the cessation of the
hemorrhage without any surgical aid. We believe it is taught in the books
that the vessels distributed to this organ always require the use of the ligature

350 The New-Orleans Medical and Surgical Journal.

or torsion, when divided with a keen bladed instrument ; here, however, the
case was not brought to the notice of the surgeon for several hours after the
violence had been committed — when all hemorrhage had entirely ceased.

Th.i notice of such facts may have an important bearing upon surgical
practice.

THE PHYSICO MEDICAL SOCIETY AND DR. FARRELL.

New Orleans, April 16, 1853.

Dr. J. Farrell.

Dear Sir — A.t a regular meeting of the New Orleans Physico-Medical Society,,
the following resolutions, which I have the honor of transmitting to you, were this
day adopted unanimously.

With feelings of lasting respect,

I remain, yours,

D. Macgibbon, M. D., Rec. Sec'y.

Whereas, it having come to the knowledge of this Society, that one of our veteran
associates, Dr. Farrell, a Vice President of this Society, is on the eve of absenting
himself for some years, with the view of residing in Edinburgh for the improvement
of his health :

Be it Resolved, That Dr. Farrell bears with him our respect and esteem
— that although his temporary absence will be felt by this Society, of which he has
ever been an active member — yet we trust his usefulness will not be lost, and that he
will meet with the appreciation which he merits as a man, and as a Physician, of high
tone.

Resolved, That a copy of the foregoing, authenticated by the signature of the
President and Recording Secretary, be furnished Dr. Farrell.

UNIVERSITY OF LOUISIANA— MEDICAL DEPARTMENT.
At the commencement of this institution, held March 17, 1853, the degree of
Doctor in Medicine was conferred upon seventy young gentlemen. Two were gradu-
ated in Pharmacy.

To the graduating class, and in the presence of a large number of spectators
Prof. T. Hunt, Dean of the Faculty, delivered an eloquent, appropriate and impres-
sive address.

E. G. Rawlings, who had been chosen by the class, pronounced quite a handsome,
and classical valedictory, in reply to Prof. Hunt's remarks. The occasion was one of
great interest to all who participated in and witnessed the proceedings.

Editorial. — City Intelligence.

851

HONORS TO DR. BENNET DOWLER.

The Royal Society of Northern Antiquarians, at Copenhagen, has elected our
distinguished fellow-citizen, Dr. Bennet Dowler, a Fellow — a high and well deserved
compliment to science and learning.

ABSTRACT OF A METEOROLOGICAL JOURNAL FOR 1853.

BY D. T. LILLIE & Co., at the City of New Orleans.
Latitude, 29, d eg. 57 min. ; Longitude, 90 deg. 07 min. West of Greenwich.

WEEKLY

THERMOMETER.

BAROMETER. 1

COURSE

FORCE
OF THE

er of
Days.

Quantity

OF THE

WIND,
Ratio

RAIN

1853.

Max.

Min

Range.

Max.

Min.

Range.

WlflD.

1 to 10.

Inches.

March 3

76 .0

47 .0

29 0

30 .30

30 .05

0. 25

SE.

3 21

0.000

« 10

76 .0

49 .0

27 0.

30.30

30 .00

0. 30

3.00

2.410

« 17

80.5

43 .0

37 .5

30 .30

29 .90

0.40

2.30

1.555

74.0

52 .0

22 .0

30 .22

29 .82

0.40

2.80

3 055

« 31

78 0

52 .0

26.0

30 .20

29.93

0.27

3 03

1.055

April 7

81 .0

57 .0

24.0

30.25

30 .00

0. 25

NW.

3..57

0.085

« 14

83 .0

63 .0

20 .0

30 .23

30. 05

0. 18

1.14

0.015

« 21

86 .0

60 .0

26.0

30 .25

29 .99

0 .26

2.86

1245

The Thermometer used for these observations is a self-registering one, placed in
a fair exposure. Regular hours of observation : 8 A. M., 2 P. M., and 8 P. M.

REPORT OF THE CHARITY HOSPITAL,

(NEW-ORLEANS,)

For February and March, 1853.

SEX.

FEB.

MARCH.

Admissions -

Males

757

683

Do. - -

Females

171

289

928

972

Discharges -

Males

712

668

Do. - -

Females

186

229

898

897

Deaths - -

Males

Do. - -

Females

Births - -

Males

Do. - -

Females

Still-born -

CALVIN PORTER, Ass't

Clerk.

852

The New-Orleans Medical and Surgical Journal.

CONTRIBUTORS TO THIS VOLUME,

Doctor Wm. P. Hort, New Orleans, two articles.

" J. C. Cummings, do.

" A. R. Nye, do.

" Josiah Hale, do.

" D. Macgibbon, do., two articles.

" Frydinger, do.

" P. B. McKelvey, do., three articles.

" E. D. Fenner, do.

" Bennett Dowler, do., two articles.

" J. H. Douglas, do.

" S. A. Cartwright, do., three articles.

" G. T. Browning, do., three articles.

" J. L. Riddell, do., four articles.

" Foster, do.

" Thomas O. Meux, do.

" G. M. Wharton, do.

" Albert Welles Ely, do. five articles.

" % J. C. Copes, do.

" R. L. Scruggs, Louisiana, three articles.

" E. A. Pye, do.

" John J. Clow, do.

" A. Ewing, do.

" R. F. Taylor, do.

^ A. Patton, Mississippi.

" B. Harvey, do.

" C. S. Magoun, do., four articles

" S. B. Malone, do.

" J. T. Kennon, do.

" V. H. Fugate, do.

" S, L. Grier, do., two articles.

" R Riley, do.

" William M. Boling, Alabama, two articles*

" J. C. Hamilton, Mobile, do.

" J. C. Nott, do. do.

" H. C. Hillhouse, do.

" F. E. Gordon, do.

" J. A. English, do.

" W. Taylor, do.

" J. C. Massie, Houston, Texas, three articles.

" Shanks, Memphis, Tenn.

" Merrill, do. do.

" P. F. Eve, Nashville,do.

" W. C. Norwood, S. C, two articles.

" Thos. D. Mitchell, Ky.

" Thomas M Logan, California, two articles.

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